Nursing homes enter into a Provider Agreement with the federal government wherein they guarantee certain services will be provided to their residents in exchange for receiving Medicare and Medicaid payments. Unfortunately, some nursing facilities then engage in nursing home fraud by failing to use those payments to provide a sufficient level of care to their residents. This can often result in nursing home abuse or neglect that seriously injures or even kills innocent patients. This is one reason that the federal False Claims Act (FCA) was enacted.
Under the FCA, individuals or companies can be held civilly liable for knowingly and fraudulently requesting monetary reimbursement from the government for services which were not actually provided.
This legislation allows a private individual called a qui tam relator, or “whistleblower,” to pursue civil damages on behalf of the government, provided that the government does not decide to step in to pursue its own administrative or judicial remedies under the law. A qui tam relator who succeeds in a False Claims Act litigation is entitled to receive as much as 30 percent of the recovery and attorneys fees collected on behalf of the federal government.
Here are some important things for those who wish to pursue a nursing home fraud case under the federal False Claims Act to keep in mind
Nursing home qui tam cases often have several factors in common, including:
- A Provider Agreement to receive Medicare and Medicaid payments;
- An insufficient and/or poorly trained nursing staff; and
- A systemic failure to offer the appropriate level of care to residents, which leads to widespread harm.
It can be critical to establish certain facts in a nursing home fraud case, such as:
- A nursing home focused on profits over safety, engaging in a pattern of increasing Medicare admissions without also increasing budgets for sufficient numbers of trained staff members;
A nursing home was too understaffed to provide appropriate types of care, which must include:
- Properly feeding residents unable to feed themselves, or encouraging able residents to eat and drink themselves, to avoid malnourishment and dehydration;
- Preventing the development of pressure sores, and treating existing pressure sores appropriately;
- Changing catheters with enough frequency to stop urinary tract infections from developing;
- Preventing the development and spread of communicable diseases or nosocomial infections; and
- Preventing residents from falling.
- Understaffing, or inadequate training in nursing staff, can result in improper medication administration along with nonexistent or haphazard medical documentation.
In the event it can be established that a nursing home continued billing Medicare for services that it inadequately or never delivered, it will be considered fraud under the federal False Claims Act.
Our St. Louis personal injury law firm takes pride in representing the victims (and their families) of nursing home abuse or neglect as they seek to hold negligent nursing facilities liable for their actions or inaction when they result in harm or death to innocent residents. We will consider all avenues to pursue cases to obtain monetary restitution for our clients, including the possibility of filing a claim under the federal False Claims Act to stop nursing home fraud.
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Source: “A Primer in the Use of the False Claims Act to Combat Fraud in a Nursing Home Case” by Gale D. Pearson. Minneapolis, MN.