False Billing to Medicare and Medicaid Fraud in Nursing Homes
Medicaid Fraud can occur in a number of different ways. In many instances, the nursing home staff will not provide the documentation needed to Medicaid or Medicare. In other instances, the nursing home make false claims to Medicare or Medicare on your behalf in attempt to bolster profits from the facility. Nursing Homes and other Medicare and Medicaid medical providers are required to only bill for actual services provided to residents. If you suspect that services billed to Medicaid and Medicare is not being provided, then it may be fraud contact a nursing home fraud lawyer to assist you investigate the matter and hold the facility or other perpetrator accountable.
Medicare and Medicaid Fraud
The rules and regulations surrounding healthcare fraud are complex, we can assist you in ensuring the care is provided as needed and that the facility is held accountable for any attempts to defraud the state or federal government. There is both a state and federal False Claims Act, create a cause of action against facilities that participate in Medicare and/or Medicare Fraud. This type of claim is often called a “Qui tam” claim and the “whistleblower” may be entitled to compensation for original source information which substantiates fraud sufficient to receive the support of the Minnesota Attorney General’s office or the federal Department of Justice.
When it comes to how you handle your finances, under the Minnesota Nursing Home Residents’ Bill of Rights, you have the right to “manage your own personal financial affairs, unless a court has decided otherwise. You may delegate this responsibility to the facility for a period of time. The facility must provide you with at least a quarterly accounting of your financial transactions.”
The Vulnerable Adults Act Prohibits Financial Exploitation of Nursing Home Residents
Minnesota Statute § 626.5572, Subd. 9. Financial exploitation.”Financial exploitation” means:
(a) In breach of a fiduciary obligation recognized elsewhere in law, including pertinent regulations, contractual obligations, documented consent by a competent person, or the obligations of a responsible party under section 144.6501, a person:
(1) engages in unauthorized expenditure of funds entrusted to the actor by the vulnerable adult which results or is likely to result in detriment to the vulnerable adult; or
(2) fails to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult.
(b) In the absence of legal authority a person:
(1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult;
(2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult;
(3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud; or
(4) forces, compels, coerces, or entices a vulnerable adult against the vulnerable adult’s will to perform services for the profit or advantage of another.
(c) Nothing in this definition requires a facility or caregiver to provide financial management or supervise financial management for a vulnerable adult except as otherwise required by law.
A nursing home billing for care they are not providing or substandard care may be participating in Medicare or Medicaid fraud for failing to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult.
If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to KlaBore@MNnursinghomeneglect.com, or call Ken at 612-743-9048 or toll free at 1-888-452-6589.