Possible Types of Fraud in Nursing Homes



A common type of fraud in nursing homes is unnecessary billing for tests and medical procedures. A nursing home may prescribe an extremely expensive medication to a patient when the reality is that he or she doesn't need that medication at all. The patient may receive medical procedures that are not required to treat his or her condition, and these procedures may even cause unnecessary pain to the patient. Family members have the right to question the medications and procedures administered to their loved one, and they should not be afraid of critiquing the use of certain medications and procedures. It may even be wise to have a second medical opinion when a patient is receiving costly drugs or requires expensive medical procedures. These expensive medications and procedures may be another way to provide “kickbacks” to pharmaceutical companies and other entities. These “kickbacks,” however, are considered illegal in the United States and violate the Fair Claims Act.

ONE SUCH EXAMPLE

Two courageous nurses who worked at Momence Meadows Nursing Center reported that they had  witnessed fraudulent billing practices at the facility to government officials who in turn conducted an investigation into how owners of the facility were providing care. After determining that the allegations of the nurses’ were well founded, the nurses were then permitted to pursue the matter against the nursing home on the government’s behalf in a case referred to as a false claims act lawsuit.

After hearing the evidence in this case, a jury in Federal Court of Southern Illinois reached a verdict against the former owner of the facility.  All told, the jury awarded approximately $28M based upon the fraudulent billing at the facility– billing for services either never provided or provided in an inferior manner. As individuals who initiated this fraudulent billing lawsuit, the nurses are entitled to a percentage of the verdict– reported to be approximately $7 million.