Misconduct at nursing home takes many forms. Of course the most well-known way that these facilities act inappropriately is when the individual care they provide to residents is substandard, resulting in falls, pressure sores, wandering, over-medication, and other neglect outcomes. One of the main ways that facilities are held accountable for those lapses are when individual families seek legal recourse by filing a civil lawsuit.
However, a lawsuit is also sometimes appropriate to hold certain home accountable for most systematic problems, usually related to overbilling and misuse of taxpayers funds. Many homes rely on Medicaid (and some Medicare) enrollees. That means that most bills are actually paid by taxpayers. There are very specific rules about what services taxpayers will and will not pay for. Yet, in a rush to increase their bottom line as much as possible, far too many homes cut corners with those rules and sometime intentionally disregard them in order to increase profits. When they occurs, the law allows private individuals with knowledge of the situation to file suit. Those individuals are usually current or former employees of the home who eventually decide that they no long can be a part of an organization that acts in such a way.
McKnight’s Long-Term Care News, for example, recently shared information on a lawsuit by a whistleblower against a nursing home chain and other outside care providers. The suit, filed pursuant to the federal False Claims Act (common in these cases) alleges that the nursing home providers received millions in kickbacks all in order to bilk Medicare and Medicaid.
It is easy to see how these arrangements can be crafted to increase the profits of both the nursing home and therapy organizations as the expense of the taxpayers. The outside therapy groups can bill the public for all of the services they provide to nursing home residents–even if they are not necessary–and if the nursing home can receive a portion of those payments (via kickbacks) for ordering the unnecessary therapy. It is a win-win for those companies. But it is obviously illegal, unethical, and damaging to the rest of us.
In this case, the nursing home company is accused of received more than $10 million in kickbacks for using therapy services in 62 different nursing homes that it operates. The two companies are claimed to have entered into an illegal subcontract where therapy services were provided by a new provider. The provider paid an up-front fee to do so and then paid 10% of its billings to the long-term care facility company. This netted millions for the nursing home.
All those with knowledge of any unethical or illegal billing practices at nursing homes in Illinois should be aware that they have legal options to bring the matter to light. In fact, laws are written to incentivize coming forward, with the whistleblower often receiving a percentage of any funds recovered in a subsequent suit. Our nursing home attorneys work on many different cases involving misconduct by these long-term care facilities, both on individual resident problems and system-wide problems.
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