Louisiana Nursing Home & Hospice Fraud Attorneys
Summary
- Anyone with evidence of fraudulent billing or inadequate care at a nursing home can be a whistleblower.
- Nursing home fraud whistleblowers who file a lawsuit on behalf of the government may receive a percentage of the recovered settlement or award.
- A nursing home fraud lawyer can help build your whistleblower case, protect your rights, and ensure you aren’t retaliated against for coming forward.
Why Hire HKGC for Your Nursing Home & Hospice Fraud Lawsuit
The private settings of nursing homes and hospices and the vulnerable population they care for make it difficult to discover fraud. And yet, hospice and nursing home fraud significantly impact many people and programs each year – programs that exist to provide crucial care and services to those who need them. Nursing home fraud whistleblowers are compensated for bravely coming forward to stop fraud and hold companies accountable, but doing so can be stressful and cause worries of retaliation.
The whistleblower attorneys at Herman, Katz, Gisleson & Cain have extensive experience with cases involving the False Claims Act and the Whistleblower Protection Act. There are laws that protect whistleblowers, but far too often, we’ve seen businesses illegally punish employees who report nursing home and hospice fraud. Our nursing home fraud attorneys have helped guide whistleblowers through the legal process and protected them from employer retaliation.
Whistleblower lawsuits are complex, but with our team’s expertise in handling nursing home fraud qui tam cases under the False Claims Act, we’ll help get the best results possible and advocate on your behalf. Contact HKGC at 844-943-7627 or submit an online contact form for a free, confidential case evaluation.
Nursing Home & Hospice Fraud FAQs
What Laws Apply to Whistleblowers?
The False Claims Act (FCA) allows private citizens to report fraud, and companies are held liable for fraudulent activities under the Act. The Whistleblower Protection Act and FCA protects whistleblowers from retaliation from their employer when they report fraud.
How Much Money Do Whistleblowers Get Paid for Nursing Home and Hospice Fraud Lawsuits?
If formal whistleblower status is granted and a lawsuit is filed on behalf of the government, the whistleblower will receive a percentage of the recovered funds or from the defendant’s settlement amount.
Why Are Whistleblowers Needed to Report Nursing Home Fraud?
Hospice and nursing home fraud would be much more difficult to identify – and not nearly as much money would be recovered – without the help of whistleblowers. Those who identify and report nursing home fraud are needed to recover the unlawful collection of funding, insurance coverage, or other payments and protect those in care, ultimately saving millions each year.
How Are Nursing Homes and Hospice Facilities Held Liable for Fraud?
When a nursing home commits fraud, there are severe penalties. A whistleblower case can recover funds from the facility, and the nursing home will face fines and may lose funding from critical programs like Medicare and Medicaid. Many nursing homes and hospices that act fraudulently shut down after a whistleblower lawsuit.
What Are the Main Types of Nursing Home Fraud?
In general, nursing home and hospice fraud occurs in two ways – through fraudulent billing, such as overcharging for care or billing for care not given, and inadequate care, including neglect or administering medications without patient consent.
What Are the Effects of Nursing Home and Hospice Fraud?
Nursing home and hospice fraud increases health insurance premiums, limits coverage available through government programs, costs taxpayers, and harms patients on a physical, emotional, and even financial level.
Types of Nursing Home & Hospice Fraud
Residents, patients, and families place great trust in the businesses and staff at nursing homes; they help with bathing, dressing, and administering medications. They provide daily meals, lifestyle activities, medical monitoring, specialized therapies, and other types of care and services. However, the extent of care and services provided at nursing homes, hospice facilities, and at-home hospice care means fraud can occur in numerous ways.
Fraudulent billing of Medicare and Medicaid is a major source of nursing home and hospice fraud. Medicare fraud costs Americans billions of dollars each year. Whistleblowers who report and gather evidence of this type of fraud save the government and, in turn, taxpayers a lot of money.
The ways that fraudulent billing occurs in nursing homes include:
- Upcoding (billing a more expensive treatment or care than what’s provided)
- Billing care that isn’t provided
- Providing non-terminal patients with hospice care
- Billing hospice care for non-terminal patients
- Duplicate billing
- Kickbacks for nursing home referrals, prescriptions, or aides
- Phantom billing
- Billing unnecessary tests and procedures
Inadequate and negligent care is another type of nursing home and hospice fraud often tied to fraudulent billing; the money-over-people mentality and deception to maximize billing affect patients’ care. The safety of these facilities and services is federally regulated, meaning that they must meet a certain standard of care. If they fail to meet these standards yet bill government programs, residents or their families, or insurance companies, it’s considered nursing home fraud.
Another way nursing home and hospice fraud occurs is when staff takes advantage of patients and residents for financial gain. Some examples are accessing a patient’s bank account, encouraging them to take out loans, and financial scams.
Benefits of Whistleblowers in Nursing Home and Hospice Fraud Cases
A main benefit for whistleblowers who report nursing home and hospice fraud is the potential compensation they receive. Once formal whistleblower status is achieved – meaning, they may file a lawsuit on behalf of the government – the whistleblower is entitled to a percentage of what’s recovered in the nursing home fraud lawsuit. Depending on the case, this could amount to hundreds of thousands of dollars for the whistleblower. That’s how important these people are in identifying and stopping nursing home and hospice fraud.
Another benefit of whistleblowers who report nursing home and hospice fraud is how it helps others. This might not be as tangible to the whistleblower as receiving compensation for what’s recovered, but it’s no less important. At the end of the day, fraud raises taxes. Whistleblowers save taxpayers money and provide people who need treatment and care the opportunity to access it. There are always people who need medical and nursing home services, but fraud takes away the money required to provide this care.
Nursing home whistleblowers help stop patient neglect, too. Often, a facility bills for services that aren’t rendered, resulting in patient neglect. How? When nursing homes operate based on the money they make instead of patient health and needs, patients are put at risk. They endure unnecessary procedures and don’t receive the care they should. Nursing home fraud often results in patients being treated poorly because the facilities put profit over care, and understaffing often occurs to keep money in the hands of the operator.
Why Consult a Whistleblower Attorney About Nursing Home Fraud
There are many reasons to consult a whistleblower attorney if you discover nursing home fraud. First, an attorney will review your evidence and, if needed, advise you to gather additional information to strengthen the case.
A whistleblower attorney with experience in qui tam lawsuits will file the lawsuit on your behalf and help persuade the government to back your case by creating the most substantial claim possible. After all, under the False Claims Act, whistleblowers who sue a nursing home for fraud on behalf of the government are entitled to a percentage of recovered funds. With an attorney on your side, you’ll get the best recovery possible for your efforts.
Another reason why whistleblowers should consult a nursing home fraud attorney is that these lawsuits are time sensitive. There’s a statute of limitations for whistleblower lawsuits to be filed, and missing the deadline or coming forward after someone else already has will affect whether or not you can file a lawsuit – and be compensated as a whistleblower.
While whistleblowers are protected from retaliation under the Whistleblower Protection Act, the fact is that employers have been known to retaliate against employees who report fraud. But with an attorney on your side, you can safely come forward, knowing that you have a team to protect your rights and push back against employers who illegally punish employees.
Finally, consulting a whistleblower attorney when you see fraud occurring at a nursing home or in a hospice setting is the right thing to do. The effects of fraud are far-reaching, and helping to stop illegal activities from happening benefits the whole system and the people who depend on it.
At HKGC, our whistleblower attorneys have the experience to file a lawsuit under the False Claims Act. We’ve helped clients who discover nursing home or hospice fraud build their case and secure a reward for their efforts, courage, and selflessness.
Effects of Nursing Home and Hospice Fraud
Nursing home and hospice fraud has widespread effects on patients, their families, taxpayers, and government programs. Patients who are given substandard care or are living in unsafe conditions may be hurt physically and emotionally. Things like neglect and administration of medications without consent take a profound toll on patients.
The cost of hospice and nursing home fraud also significantly impacts government programs that fund these facilities and services. Fraudulent billing lowers the available funding for services, care, and people. Programs like Medicare and Medicaid can only cover so much, and when it’s wasted on false claims, everyone who relies on the system, from patients to care facilities, loses out.
Stopping nursing home and hospice fraud requires the help of brave whistleblowers who discover what’s happening, report it, and have an integral role in recovering stolen funds. While the government regularly audits nursing homes and reviews claims to ensure fraud isn’t occurring, there are far too many facilities and businesses nationwide for the government to stop what’s happening on its own. Not to mention, there are numerous ways that hospice and nursing home fraud can occur, and fraudsters have gotten very good at concealing what they do.
Example Whistleblower Cases of Nursing Home and Hospice Fraud
Each year, nursing home and hospice care fraud happen across the U.S. Numerous cases expose the depth of fraud occurring in these healthcare settings and among those who work for companies that provide essential care and support to vulnerable populations.
In 2022, settlements and judgments under the False Claims Act were the second highest in history. Healthcare industry fraud, including nursing homes and hospice organizations, accounted for $1.7 billion of the $2.2 billion recovered.
Fraud is a lucrative industry that harms the American people. The following are some notable whistleblower cases of nursing home and hospice fraud.
$30 million settlement agreements for false rehabilitation services
Signature HealthCARE reached a $30 million settlement for False Claims Act violations by submitting unreasonable, unnecessary, and unskilled services to Medicare patients to bill the program for the most possible money. The whistleblowers in the qui tam lawsuit were two former nursing home employees.
$48 million settlement for inflated bills for therapy sessions
Two whistleblower lawsuits against a Los Angeles nursing home operator reached a $48 million federal settlement agreement for charging Medicare for therapy sessions that never happened or were unnecessary. The Medicare fraud case was brought forward by whistleblowers, who were former employees of Ensign Group Inc., a company operating multiple nursing homes.
$5.5 million settlement for hospice fraud
A whistleblower discovered the hospice business they worked for was defrauding the government, and the case resulted in a $5.5 million settlement. The Indiana-based company allegedly billed Medicare for hospice services already covered by patients’ Medicare plans.
