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Healthcare Fraud

Florida Nursing Home Quality of Care Violations

What is a Nursing Home “Quality of Care” Violation?

Quality of care is a measure of the care that patients receive at nursing homes. Residents of these homes have a right to expect safety, hygienic environments, and the appropriate treatment. When nursing homes take money from the government, it’s not only the patient’s expectations that matter.

When any nursing home bills Medicaid of Medicare (for skilled nursing care), they are declaring that their services are up-to-standard. That means low-quality services don’t merely harm the patient—they also represent fraud against the government. That fraud can be prosecuted severely using the False Claims Act.

Can the False Claims Act be Used Against Negligent Nursing Homes?

Yes, the False Claims Act can be used against nursing homes that don’t provide a reasonable level of safety and security. It may help to understand what the FCA is, whether it’s been used against nursing homes, and why it matters.

What is the False Claims Act (FCA)?

The FCA is a set of laws that were passed to prosecute fraud against public programs. It strengthened the penalties against fraud and encouraged whistleblowers by providing a substantial reward.

Abraham Lincoln himself signed the act into law so that it could be used against war profiteers who were providing shoddy goods to soldiers.

In the past, FCA cases have been brought against hospital networks, major military contractors, and ambulance services.

Is the government using the FCA in nursing home cases?

Yes, the FCA has been used against nursing homes and is now being used more often. Beginning in the early 2010s, legislators and law enforcement leaders were already looking into the ways that the FCA could be applied to care violations.

Public programs such as Medicare cover a large portion of the elderly who are receiving care at nursing home facilities. That made pursuing fraud a priority.

In recent years, dozens of successful cases have been brought against nursing homes. Some cases revealed millions of dollars worth of fraud. It is likely that these cases will increase in number in the coming years. The DOJ has formed a task force to pursue these violations with even more focus.

Does that mean that whistleblowers can be rewarded?

Yes, whistleblowers can be rewarded for reporting abuse and fraud at nursing homes. Part of the FCA is a Qui Tam provision that entitles whistleblowers to a percentage of certain fines or money recovered.

It is particularly important that employees be willing to blow the whistle on nursing homes in Florida. This state has one of the largest retired populations in the country, and abuse that’s allowed to continue can spread across massive networks of care centers.

Whistleblowers have been involved in many of the largest nursing home cases to date.

What Nursing Practices may Violate the FCA?

The FCA has been used against nursing homes for many types of abuse. Any practice that results in substandard care may constitute fraud if it is billed to the government. Here are some examples of practices that have been prosecuted in recent history.

Negligent care, resulting in injury

Any care that results in frequent, preventable injuries to residents may result in fines, the stripping of federal funding, or more severe penalties. Violations of this type can attract law enforcement attention very quickly because of the public outrage that surrounds these cases.

Negligent care attracted a series of penalties for Parkview Healthcare Center starting in 2012. Among other issues, the facility failed to make necessary modifications to one resident’s wheelchair. This resulted in a series of injury-causing falls.

The facility was charged more than $100,000 for this series of injuries.

Financial fraud against residents (Melissa Meole)

Residents in nursing homes are unfortunately, very susceptible to fraud. Many conditions that affect the elderly lead to memory loss and this can allow unscrupulous staffers to make unjustified charges using resident’s accounts.

Nursing homes that fail to properly vet their staff, or report and stamp out fraud wherever it happens, may expose themselves to FCA cases. In March 2020, the government laid down charges against more than 400 people accused of being involved in nursing home fraud.

The charges involved cases where caretakers, administrators, and other nursing home staff were accused of embezzlement, wire fraud, bank fraud, and identity theft.

Overbilling through unnecessary therapy

Nursing homes are permitted to bill for extra services that seniors may require during care. These services include specialist-provided services, such as therapy. When nursing homes are billing for the services, but not providing them, FCA cases can be brought.

The Saber Healthcare Group paid a large settlement to resolve claims that it was fraudulently billing Medicare for therapy services that were not being provided. In cases filed around the same time, nursing homes were accused of billing TV time as therapy and calling it therapy.

The three whistleblowers who helped bring the case are splitting $1.75 million of the $10 million in fines that were applied as part of the settlement.

How to Blow the Whistle on a Nursing Home

Do you know about any abuse that is happening in a nursing home? Is inadequate care being billed to Medicaid or Medicare? If so, you may be able to assist as a whistleblower. Please preserve any evidence you have, and speak to a whistleblower lawyer.

A lawyer who focused on whistleblower cases can help you understand what to expect in cases like these. Fast action against fraud may save lives and entitle you to a percentage of recovered funds.