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.