If the bills for your loved one’s stay in a nursing home are significantly higher than before or what the facility told you they would be, the long-term care center might be committing healthcare abuse and fraud. A lawyer might be able to investigate, and hold the facility accountable and go after your losses.
Call Pintas & Mullins Law Firm today at (800) 842-6336 to get started and learn more about healthcare abuse and fraud in nursing homes. The initial consultation is free, and we work on a contingency-fee-basis, so you pay nothing unless we win for you.
Types of Nursing Home Medicaid Billing Fraud
Healthcare abuse and fraud in nursing homes, specifically billing fraud, is so pervasive that the Department of Justice created Medicaid Fraud Control Units (MFCUs) to root out common healthcare abuse scams at nursing homes like these:
- Billing for services or items that the resident did not receive. For example, if a resident receives physical therapy at the facility, the center might tack on additional charges for splints the patient did not receive and therapy sessions that never happened.
- Billing for patients who do not exist. It sounds outrageous, but some nursing homes send invoices to Medicare and Medicaid for people who are not residents of the facilities. The center might continue to bill for a patient who left the facility to live with family members. Some nursing homes keep charging the government after a patient dies, until Medicare or Medicaid notice and make the center stop.
- Double billing is a common tactic. The same charge might appear multiple times on a monthly bill, even though the patient received the goods or services only once. Unscrupulous nursing homes rely on the confused state of many of their residents to get away with this billing fraud.
- A facility might perform one procedure but bill the resident or Medicaid for a more expensive one. For example, a skilled nursing facility might perform a simple X-ray on a patient but charge him or her for a magnetic resonance imaging (MRI) study.
- Some long-term care centers line their pockets by providing expensive goods or services that the resident does not need or request. For example, a facility might run routine chest X-rays on residents during flu season to check for pneumonia, even on patients with no symptoms of the illness.
- Medicare, Medicaid, and long-term care insurance do not cover every possible service or good that a facility might offer. Some nursing homes bill for uncovered products and services, creating a financial hardship for the resident or his or her family. The center should disclose in advance if an item is an out-of-pocket expense.
- A nursing home might encourage residents to participate in organized activities and outings. If the facility does not include the cost of these events in the standard monthly charge, the center should inform the residents of the additional expense ahead of time. The facility might pressure or embarrass residents into participating in these events—which are not always free.
- Some doctors and hospitals get kickbacks from nursing homes for sending their patients to the facilities. While these kickbacks do not come directly out of the resident’s pocket, these bribes increase the cost of doing business for the participating nursing homes, which adds to the high charges to live at a long-term care facility.
Medicare and Medicaid are the top single-payers of nursing home expenses in the United States. If a facility is willing to defraud the federal government and risk time in prison as a result, the center will likely try to defraud its private-pay residents and other sources of funding as well, using the same or similar tactics.
Fraud and Misuse of Other Resources
Nursing homes that defraud Medicare and Medicaid often also commit healthcare abuse and fraud by misusing the funds of:
- Private-paying patients
- Social Security benefits
- Veterans’ benefits
- Long-term care insurance proceeds
You should always insist on a written statement for each month that your loved one stays in a nursing home. Read the paperwork carefully and look for charges that the facility said were part of the package of services provided. Check for double billing. Make sure that your loved one actually received the services on the invoice instead of a less expensive item or procedure.
For a no-cost consultation, call Pintas & Mullins Law Firm today at (800) 842-6336. We do not shy away from tough cases.
How to Prevent Healthcare Billing Fraud
Similar to private health insurance companies, Medicare will send beneficiaries statements of processed claims. The Centers for Medicare & Medicaid Services advises that patients protect themselves by checking these papers against their records to discover errors. The easiest ways to create a record of the healthcare services you received are to:
- Write all medical appointments and services on your calendar.
- Keep all bills and receipts for services and goods from providers.
If you notice an error, contact Medicare right away. If you have a different form of benefit that pays for your healthcare, like a long-term care insurance policy, use the same techniques.
Frauds That Sometimes Partner With Unethical Nursing Homes
Never give your Medicare number to anyone who calls on the telephone or sends you an email or paper mailing. Many of the companies that offer free screenings or other services are scams. Some use high-pressure tactics to try to sell you expensive products or tests. Others collect your personal information and send fraudulent bills to Medicare for goods and services you did not receive.
Legitimate Medicare plans will not call you and enroll you over the phone. However, you can enroll over the phone if you initiated the phone call. Medicare plans cannot go door to door selling their product.
Healthcare abuse and fraud happens in every ZIP code. You need to be aware of con-artists who try to commit healthcare abuse and billing fraud in nursing homes.
We handle these cases on a contingency fee basis, which means that we do not charge any upfront legal fees. You will have no out-of-pocket costs. Our fees will come out of the settlement or court award. We do not get paid until you win.
Call Pintas & Mullins Law Firm today at (800) 842-6336 for a no-cost consultation. The initial consultation is free, and there is no obligation.