Nursing homes and hospice providers are entrusted with caring for some of the most vulnerable members of our communities. These facilities are expected to follow strict federal and state standards, deliver appropriate medical care, and use government funds responsibly. Unfortunately, that trust is broken far too often.
Nursing home fraud not only steals taxpayer dollars but also puts patient safety at risk, burdens families, and drains public programs like Medicare and Medicaid.
For individuals who witness this wrongdoing, stepping forward can be daunting. But nursing home and hospice whistleblowers play one of the most important roles in exposing and stopping fraud. At Herman, Katz, Gisleson & Cain (HKGC), our whistleblower attorneys can help clients safely report nursing home fraud, protect them from retaliation, and file cases under the False Claims Act.
Impact Nursing Home Fraud Has on Residents & Families
First and foremost, fraudulent billing practices such as upcoding, billing for services never provided, altering medical records, or admitting ineligible patients to hospice care negatively affect the nursing home residents. According to the U.S. Department of Health and Human Services Office of Inspector General (OIG), fraudulent activity often goes hand-in-hand with poor care, unsafe environments, and neglect.
Poor Quality of Care
Facilities that prioritize profit may understaff shifts, skip essential services, or provide unskilled or rushed care. Residents may go without proper bathing, mobility assistance, or monitoring.
Medical Errors and Unsafe Practices
Fraud is frequently tied to unnecessary or improperly provided treatments. Medication mistakes, preventable infections, and avoidable hospitalizations are common in facilities where finances override patient safety.
Active Neglect
Some nursing homes bill Medicare and Medicaid for services that were never given. Billing without care can leave patients physically vulnerable and emotionally distressed. Also, living in an unsafe or neglectful environment can cause anxiety, depression, fear, and loss of trust. For elderly residents, these emotional harms can be just as devastating as physical injuries.
Fraud in the nursing homes creates a ripple effect that reaches far beyond the residents. Families depend on these facilities to support loved ones when they can no longer care for themselves. Realizing a loved one is not receiving the care they were promised is deeply painful. Families often struggle with guilt, frustration, and outrage when they uncover nursing home neglect or abuse.
Fraud can also force families to take on additional costs such as hiring private caregivers, paying out-of-pocket for supplemental services, or moving a loved one to a new facility. Nursing home fraud damages confidence not only in a single provider but in the entire long-term care system.
How Nursing Home Fraud Drains Government Programs
In recent years, Medicare fraud in nursing homes has surged, prompting serious concern from legal experts and whistleblower attorneys. Medicare and Medicaid together account for a staggering portion of U.S. healthcare spending, yet insiders estimate that $100 billion or more is lost to fraud each year, with nursing homes being a major contributor. When providers submit fraudulent claims, the impact is felt across the country. Every fraudulent claim reduces funding for legitimate medically necessary care for seniors, people with disabilities, and terminally ill patients.
Nursing home fraud forces taxpayers to carry the burden of inflated costs, and it also places a strain on government resources. Government agencies must dedicate significant effort to investigating fraud, conducting audits, and taking enforcement actions—resources that could otherwise support quality-improvement initiatives and patient protections.
The complexity of billing systems, combined with automated claims submissions, makes it difficult for regulators to detect false or inflated claims from nursing homes or hospices. This makes whistleblowers more critical than ever: their inside knowledge can expose the schemes that regulators might otherwise miss and help recover taxpayer dollars that should be funding real patient care.
Why Whistleblowers Are Essential to Stopping Nursing Home Fraud
Government agencies cannot uncover every false claim or case of neglect on their own. Nursing home employees, administrators, and even family members may be the first to notice fraud and play a critical role in bringing these schemes to light.
The U.S. Department of Health and Human Services encourages individuals who suspect fraud, abuse, or unsafe conditions in a nursing home to report them. You don’t need proof—only a reasonable concern that a resident’s safety or government healthcare funds may be at risk. Reports can be made by phone at 1-800-HHS-TIPS or online at TIPS.HHS.GOV. You should also follow any state-specific reporting requirements posted within the facility, which may include contacting your state’s long-term care ombudsman. For situations involving immediate danger or physical harm, call local law enforcement.
At HKGC, we have significant experience representing whistleblowers in nursing home and hospice fraud cases. Our firm can help you navigate the legal process, protect your rights, and pursue claims under the False Claims Act, which allows the government to recover funds and hold facilities accountable. We understand the personal and professional risks involved, and we know how to build strong cases that expose wrongdoing while shielding our clients.
If you suspect fraudulent billing, substandard care, or neglect in a nursing home or hospice setting, contact us online, via live chat, or call 844-943-7627 for more information or to submit a free, confidential case review.
