Healthcare workers and families of those in nursing
homes should pay particular attention to services provided so as
to ensure that family members and patients receive the quality of
care to which they are all entitled. Additionally, bills
should not be inflated for services that are inappropriate for a
patient or which overstate the services provided.
An example of a nursing home-related False Claims
Act violation would be billing for individual psychotherapy by a
physician (at a high billing rate), when in fact the patient, who
was hearing-impaired and unable to effectively benefit from the
therapy, instead actually attended a group therapy session
conducted by a social worker (whose billing rate should be lower
than that of the physician therapist).
Unless healthcare workers or family and friends of
the patient speak up, such frauds can continue indefinitely, as
the patients cannot themselves investigate or actively pursue the
issue. It will be up to others to expose the wrongdoing and
protect both the patients and the public Medicare and Medicaid
funds.
