Nursing Home and Healthcare Fraud Cases

Kentucky nursing homes and other nursing homes and healthcare facilities across the United States have problems with nursing home abuse and neglect of their patients. However, other types of abuse may be occurring as well such as nursing home or healthcare fraud. This is when a nursing home or other healthcare facility may bill Medicaid or Medicare as well as other insurance companies for extra supplies that are not needed or extra care for patients that they do not actually receive. If you are a family member of someone in a nursing home or a staff member at the home and you suspect fraud has taken place, it is recommended that you talk to a Kentucky nursing home and whistle-blower lawyer right away. They will work with you and decide if you have a case to file a lawsuit according to the False Claims Act.

The False Claim Act rewards people that are brave enough to report fraud that has been committed against the government. These people are known as "relators" under the act. A whistleblower, or relator, is entitled to receive a payment of 15% to 25% of any amount the government recovers. In nursing home and medical fraud cases the recovery can often add up to millions of dollars. Additionally, if the government decides not to join a qui tam lawsuit and the realtor proceeds without the government the whistleblower can retain 25% to 30% of any sum recovered.

There are several types of nursing home or healthcare facility fraud that is often committed to gain more money from Medicaid or Medicare. Some of these types of fraud may include:

• Sending bills to the insurance for services that patients did not receive
• Sending bills to insurance for supplies that were not needed or used
• Providing extra payments to medical professionals who refer patients to the nursing home
• Providing false or inaccurate information on documents in order to receive additional payments
• Billing the insurance more than once for a service or supplies that have already been paid for

Lawsuits can also be filed against nursing homes or healthcare facilities if they submit inaccurate information on the annual cost report. These reports must be provided to the federal government if the nursing home receives funds from Medicaid or Medicare. A list of all services and medical equipment and supplies needed and used must be listed in this report. If a nursing home provides inaccurate information on these reports in order to receive additional funding or payments, this is another type of fraud.

Kentucky and other nursing homes are also required to follow federal and state regulations and guidelines when giving their patients necessary medical treatment and care. The nursing homes are also required to follow certain safety environment guidelines. If a nursing home is requesting payments or additional funding for supplies or care from Medicaid or Medicare but they are failing to meet these guidelines the nursing home can be held responsible for fraud according to the False Claims Act.

If a member of the staff or a family member of a patient at a nursing home suspects that fraud has occurred, you can file a whistle-blower lawsuit against that facility. The most common types of people who blow the whistle on fraud in these cases include:

• Administrators at the facility
• Medical staff
• Accountants at the facility
• Medical billing and coding staff
• Consultants and contractors

If you are a family member of a patient at nursing home or you currently or formerly worked for the nursing home where you think that fraud has occurred, then we strongly advise you to speak with one of our caring and knowledgeable Kentucky nursing home and whistle-blower attorneys at the Higgins Firm immediately. We will review your case and help you determine if a lawsuit is necessary. If it is, we can also help you receive any compensation you may be entitled to for helping to expose the fraud.

Contact us online or call us at 800.705.2121 to set up a FREE consultation to discuss your legal options.