There are various kinds of nursing home fraud.  The most common kinds involve Medicare/Medicaid fraud where a nursing home falsely bills for supplies covered under Medicaid.  For example, a nursing home might order adult diapers, which are not covered by Medicaid, and then report it as some kind of sophisticated prosthetic, which could be covered by Medicaid.  This kind of fraud can affect all taxpayers since Medicare and Medicaid are publicly funded programs.  Other types of fraud include, but are not limited to:

  • Falsifying documents to avoid liability, including entering false numbers, misreporting nurses on duty and faking signatures.
  • Misrepresenting medical records to obtain additional payments
  • Administering and then billing for unnecessary procedures or tests
  • Taking payments, gifts or rewards from pharmaceutical companies or medical device makers for using or promoting their products and/or services

What Can I Do to Prevent Nursing Home Fraud?

Healthcare workers and people who have family members in the care of a nursing home should pay particular attention to the services being provided to patients.  If the bills are inflated for services that the patient does not need, or if they overstate the services being provided, the nursing home could be violating the Fair Claims Act.

Can a Nursing Home Be Liable for the Actions of Its Employees?

Employers can be held accountable for the actions of its employees while the employees are working. It would be the nursing homes responsibility if the employee misrepresents supplies, records, or charges.

What Is Required For a Nursing Home Fraud Case To Move Forward?

Nursing home fraud relies on the same premises as other cases involving fraud. To properly establish fraud, the following must be proven:

  • Nursing home misrepresented a material fact
  • Nursing home made misrepresentation knowingly
  • Nursing home made misrepresentation with intent to defraud plaintiff
  • Plaintiff relied on nursing home’s misrepresentation
  • Plaintiff was injured by nursing home’s misrepresentation as a result

Nursing Home Misrepresented a Material Fact

A growing tread in nursing homes is that they are often understaffed, resulting in necessary care being neglected. Sometimes however, the employees record that the care was provided, keeping family members of patients in the dark about their loved one’s condition.
A patient, for example, may require a certain level of medication a week, but the nurses neglect to provide the total amount. If the nursing home records that all medication were given for that week though, nobody may suspect that something is wrong until the patient is in danger.

Nursing Home Knowingly Misrepresented To Plaintiff

Nursing homes can only be liable for fraud if they knowingly wronged the plaintiff. This does not mean that ignorance is a total defense. It is reasonable to assume that managers would check that employees are present when they clock in or that a nurse would make sure that a patient is getting 10 hours of exercise a week before recording that information on a report.

Nursing Home Had Intent to Defraud Plaintiff and Plaintiff Relied on Nursing Home’s Misrepresentation

If the information given by the nursing home is crucial for the patient’s wellbeing, misrepresentation can prevent the patient or his family from making correct decisions. Furthermore, false medical records can result in doctors or other medical professionals from administering the correct treatment if future complications come about in the future.

Nursing homes which falsify documents to prevent liability and avoid responsibility may be committing obstruction of justice.

Plaintiff was Injured by Nursing Home’s Misrepresentation As a Result

Like all cases which go before a judge, the party bringing the suit must suffer an injury. Since nursing homes are charged with caring for the elderly, misrepresenting or misinforming the patient and/or her family can result in dire consequences, such as infections, further illness or even wrongful death.

The injury, however, need not be physical. The plaintiff must simply have suffered some kind of loss. For example, a nursing home which administers and bills for unnecessary tests may represent a needless financial burden on the patient and her family, resulting in not only a loss of money, but also time away from other obligations.

If I Think a Nursing Home Is Committing Fraud, What Should I Do?

Contact a nursing home abuse lawyer immediately to be advised of your rights and of what action you can take.  If you have been over-billed for unnecessary services you may be entitled to compensation.  Additionally, your lawyer may want to contact your state’s attorney general to discuss the possibility of criminal charges against the nursing home.