Two nurses who brought qui tam claims on behalf of the government allege their nursing home employer knowingly submitted thousands of false claims to the Medicare and Medicaid programs have had judgments in their favor reversed by the U.S. Court of Appeals for the Seventh Circuit. Although a jury awarded the government $3 million in compensatory damages, imposed $19 million in fines and awarded the nurses a total of $412,000 for retaliation, the appellate court found the verdict was not supported by the evidence.
It’s unclear whether the government will seek review of that verdict, but we do know that these kinds of accusations arise from situations that occur routinely in nursing homes across the country. Aside from submitting invoices for payment of services never given, nursing home providers sometimes render services to patients that aren’t necessary and, in some situations, could even be harmful. They know patients may not be able to speak on their own behalf, and they also know providing these “services” is lucrative.
In some cases, claims may be submitted for government reimbursement even though the care standard is lacking. That was the basis for the underlying claim in Absher v. Momence Meadows Nursing Ctr., Inc. before the U.S. Court of Appeals for the Seventh Circuit.
If the nursing home provider where your loved one is staying is investigated for Medicaid fraud, it’s worth exploring whether your loved one may have been receiving harmful treatments, medication or therapies he or she did not need. Even absent an investigation, family members have the right to question medications and procedures administered to their loved ones, and it’s especially important if the patient is the recipient of costly medical procedures or expensive medications.
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