Federal and state laws prohibit healthcare providers from submitting overstated bills to the government. These laws are generally called false claims act or qui tam cases and the person who blows the whistle may recover damages. False claims can take many forms including overstated invoices and out and out theft.
In the nursing home field, companies receive compensation from the government through Medicaid reimbursements. The amount of money a nursing home receives from the government for each resident under Medicaid generally depends upon the level of care each resident requires. Information about the level of care each resident requires is relayed to the government by the nursing home, and the government in turn pays the nursing home a reimbursement rate based upon the information it receives from the nursing home.
So what happens if the information provided by the nursing home to the government is inaccurate?
That is precisely what was alleged to have been the case in a lawsuit filed in New York against the company that operated the Glen Island Center for Nursing and Rehabilitation, US v. Ralex, No. 10-CV-0822 (EDNY 2010), that recently settled.
In that case, it was alleged that the nursing home completed quarterly assessments of the level of care each resident required but relayed falsified assessments in forms submitted to the government, called Patient Review Instruments, that were used by the government to reimburse the nursing home under Medicaid. The alleged result was that the nursing home received fraudulently inflated Medicaid reimbursement rates for each resident.
If you work for a healthcare provider that is overstating its bills to the government, or contending that services are required when in fact they are not, call the employment lawyers of Alan Lescht and Associates, P.C. for a free consultation.