Nursing Home Whistleblowers Can Report Fraud and Receive a Large Reward
At Senior Justice Law Firm, we specialize in nursing home abuse litigation. Our lawyers can uncover all kinds of misdeeds committed by facility owners, however; the most powerful weapon in combating injustice in nursing homes is the whistleblower. These brave individuals have been awarded millions of dollars for exposing fraud and corruption inside long term care facilities, like nursing homes and assisted living facilities.
Our lawyers can help whistleblowers expose Medicare fraud in nursing homes. Call our law firm today and speak with our lawyers in your confidential, no-obligation nursing home whistleblower case consultation: 888-375-9998.
We view every individual nursing home negligence case as a potential whistleblower case. As a nursing home injury case gets deeper into litigation, we speak with employees that may have personal knowledge of ongoing billing fraud in the nursing home corporation. These whistleblowers may be entitled to a large monetary award via a qui tam lawsuit.
Nursing Home Whistleblower Verdicts and Settlements
- Nursing home management corporation provides grossly substandard services to residents (pending)
- Chronic understaffing ($28 million verdict)
- Company wide Medicare fraud ($1.7 billion million settlement)
- Overbilling for services and therapy ($347 million verdict)
- Upcoding resident needs ($125 million settlement)
- Billing Medicare for unneeded services ($38 million settlement)
- Widespread neglect of residents and ‘substandard’ ‘deficient’ ‘worthless’ services provided to residents ($5 million settlement)
Unsure if you can expose a multi-million dollar Medicare fraud in the nursing home? Call our lawyers today for your confidential consultation at 888-375-9998.
It Pays To Be A Nursing Home Whistleblower
Our government recognizes the need to reward inside employee Whistleblowers with financial rewards to incentivize exposing nursing home fraud. To accomplish this, Whistleblowers are entitled to a percentage of the fraud exposed (typically 15% to 25% of the total fraud recovery). This can translate into huge sums of money. For example, if a nursing home therapist reports a $20 million dollar Medicare overbilling fraud, he or she will receive anywhere from $3 million to $5 million.
How To Report Nursing Home Fraud as a Whistleblower
In order to receive the above reward money, a whistleblower must hire a nursing home fraud attorney to file a qui tam lawsuit against the nursing home. This is usually done under the False Claims Act.
What is a Qui Tam Case?
Qui tam lawsuits are civil lawsuits brought by whistleblowers under the False Claims Act. Through the False Claims Act, a reporting whistleblower is entitled to a percentage of the fraud that he or she exposes. Qui tam cases are typically filed by law firms familiar with the given sub-specialty that the fraud involves.
… But I Cannot Afford a Nursing Home Whistleblower Attorney
There is no need to worry about paying an attorney by the hour with qui tam litigation. Our nursing home fraud attorneys work on contingency fee only. This means we only get paid if you make a recovery. There are no up front costs or fees. Our nursing home whistleblower lawyers assist in bringing the case to the appropriate assistant US attorney for review.
For more information, or for your free nursing home Medicare fraud case evaluation, call us now at 888-375-9998.
Nursing Home Qui Tam Case
How Do I Know if I Have a Nursing Home Fraud Case?
Medicare and Medicaid are the usual targets of nursing home billing fraud. Here are examples of prior successful whistleblower actions against nursing homes:
- Inappropriate or Unnecessary Treatment
- Billing for services that were not provided. If a nursing home bills for physical therapy and residents do not receive it, this is obvious Medicare fraud.
- Inadequate treatment. Medicare typically pays a nursing home a per diem rate for each resident. If a nursing home whistleblower comes forward and shows that the facility failed to provide the appropriate tests, scans, medicine, staff members, doctor visits or supplies in order to maximize profits, Medicare may seek restitution through a whistleblower lawsuit.
- Unnecessary treatment. Forcing a non-rehab resident to undergo rigorous therapies in order to bill can be grounds for a nursing home Medicare fraud claim. Extending therapy after the therapist recommends discharge is also fraud.
- Upcoding Medicare RUG Scores
- Upon admission to a facility, each resident’s rehabilitation and nursing needs are memorialized in a code. This is known as a RUG score. This RUG score determines reimbursement rates for the resident. Nursing home chains are notorious for upcoding RUG scores to ‘ultra high’ in an effort to maximize profits.
- Misrepresentation of the Healthcare Provider Providing Services
- Medicare will pay for services based on the healthcare provider that performed them. For example, a certain service may fetch a higher reimbursement if performed by an R.N. as opposed to a Nursing Assistant. When nursing homes lie about provider credentials in order to overbill Medicare, this is fraud. If nursing homes routinely use the incorrect provider ID numbers (PIN numbers) and bill for physician or nurse time when they were not there, this is grounds for a nursing home qui tam lawsuit.
- Upcoding or Improper Coding of Supplies, Services & Therapy
- Submitting false claims to Medicare or ‘upcoding’ services like therapy or supply costs is fraud. Look for corporate memos from management on which billing codes to use for which services. If they do not match the actual service provided, chances are it is a form of Medicare upcoding.
- Bundling and Unbundling of ‘Package’ Services
- Depending on which services are being provided to a patient, Medicare will recommend that the nursing home ‘bundle’ the services into one billing code. Despite this, some corporate facility owners instruct their nurses and therapists to unbundle the procedures, in order to make the reimbursement higher.
- Lying About Where a Service Was Provided
- Reimbursement rates may differ depending on if the service or therapy was provided in a doctors office, in a nursing home or in a third party therapy office. Lying about the location of the therapy or service constitutes nursing home Medicare fraud.
The Steps in a Nursing Home Fraud Whistleblower Lawsuit
Step 1: Isolate Proof of the Fraud
Medicare fraud and overbilling in a nursing home can take many forms. Examples include forcing therapy on residents that do not need it, billing Medicare for supplies that are not given to residents, overbilling for services, upcoding RUG scores and billing both Medicare and Medicaid for the same thing. Whatever type of fraud is being committed, save emails, bills, photos or memos which prove guilt on management’s part.
Step 2: Join Forces With a Nursing Home Whistleblower Attorney
Call our law firm at 888-375-9998 to retain our law firm at no cost to you. Note: it is not enough to simply call Medicare and report fraud. In order to receive a monetary reward, you must hire a Medicare fraud attorney who will file your qui tam lawsuit. Your nursing home fraud attorney will then file your civil whistleblower suit, in the hopes that the government.
Step 3: The Government will Accept or Reject Your Whistleblower Claim
Once filed by your nursing home whistleblower attorney, you must wait to see if the US Attorney accepts or rejects the claim. Our lawyers work closely with the AUSA’s office and ‘package’ the case to make the government’s job as straightforward as possible. This can take some time. In order to better your the success of the claim, make sure to keep all potentially relevant documents and evidence of the fraud.
Step 4: Settlement or Trial of the Nursing Home Fraud Case
Your case will either be settled (with the nursing home or corporation paying back Medicare) or tried to a verdict. Most Medicare whistleblower cases do settle without having to go to trial. The US attorney’s office routinely reports settlement amounts.
Step 5: Your Medicare Fraud Whistleblower Award
Successful whistleblowers typically recover around 20% of the total fraud exposed. This means, in a case exposing $20 million in Medicare fraud, the relator can expect to recover ~$4 million.
Questions on Your Qui Tam Nursing Home Whistleblower Lawsuit?
Do not be afraid to do what is right. Speak with our experienced nursing home whistleblower attorneys today in your 100% confidential case consultation. Together, we can put an end to fraud and abuse inside America’s nursing homes.
Senior Justice Law Firm focuses its practice on nursing home abuse cases. Our experienced and compassionate trial lawyers are here to help you with your potential nursing home fraud claim. Call us today to begin the conversation at 888-375-9998.