Nursing homes and long-term care facilities provide care to elderly individuals and others who are unable to care for themselves and are often funded by government programs like Medicare and Medicaid. While many of these facilities operate ethically and provide residents the expected level of care, others engage in illegal, improper, or fraudulent business practices in an effort to maximize their profits. When nursing homes submit false records and billing information to obtain more money from government-funded healthcare programs than they have a right to claim, they could be committing illegal acts of fraud.
Whistleblowers who bring forward valuable information regarding nursing home fraud in Chicago could be eligible for financial compensation if their case results in the government recovering defrauded funds. If you have proof of nursing home or long-term care facility fraud, contact the Chicago nursing home fraud whistleblower lawyers of Tycko & Zavareei LLP today for a free legal consultation.
What is Nursing Home Fraud?
Nursing home fraud occurs when healthcare workers engage in unethical business practices like fraudulent billing and other violations of the False Claims Act (FCA) in order to obtain unjustified funds from government programs like Medicare and Medicaid. Nursing homes and other care facilities may commit fraud by:
- Billing for unprovided services
- Failing to provide adequate treatment
- Billing for medically unnecessary treatment
- Billing for services and treatment provided to patients who do not qualify for that specific level of care
- Misrepresenting the qualifications of the healthcare worker providing services
- Upcoding or falsifying claims regarding the level of services, supplies, and therapy provided
- Billing for services separately that are usually bundled together, known as unbundling
- Offering or providing kickbacks
- Misrepresenting where services were provided
Laws Helping Fight Nursing Home Fraud
Federal False Claims Act
The False Claims Act (FCA) is a federal law that makes it illegal for any individual or organization to intentionally submit false or misleading claims to any federally funded program with the intent of procuring unwarranted funds. Under the FCA, the qui tam provision allows private citizens to bring a qui tam lawsuit on behalf of the federal government against the person or business committing fraud.
Whistleblowers who bring successful FCA lawsuits that lead to a settlement or the recovery of defrauded funds could be eligible for a significant financial reward. If you have proof of nursing home fraud or other forms of healthcare fraud occurring in Chicago, contact the lawyers of Tycko & Zavareei LLP today for a free legal consultation.
Illinois False Claims Act
Enacted in 1991, the Illinois False Claims Act allows private citizens with knowledge of fraud against the Illinois state government to bring a qui tam lawsuit against the individual or business committing fraud. Like the federal False Claims Act, Illinois’ FCA offers whistleblowers potential financial rewards and protections from retaliation.
How Prevalent is Nursing Home Fraud in Chicago?
Each year, the US government spends trillions of dollars on healthcare through programs like Medicaid and Medicare, which are funded by tax revenue. According to a Congressional Research Center report, Medicaid spent over $180 billion on long-term services, including nursing facilities, and Medicare spent $87.5 billion in 2019 alone. Experts estimate between three and 10 percent of all healthcare claims the government pays out are fraudulent, resulting in the loss of billions of dollars each year.
Hundreds of nursing home fraud qui tam claims are filed each year, with many leading to significant settlements. In 2019, a physical therapy center and four nursing facilities in the Chicago area were ordered to pay nearly $10 million for committing Medicare fraud by providing patients with medically unnecessary treatments.
Why Should I Report Chicago Nursing Home Fraud?
Because government programs like Medicare and Medicaid are funded by tax revenue, taxpayers ultimately pay the price for funds lost by the government due to nursing home fraud. Employees and others with inside knowledge are encouraged to come forward with evidence of nursing home fraud or other forms of healthcare fraud and are offered protection and potential compensation for their actions as whistleblowers.
How Are Chicago Whistleblowers Compensated and Protected?
The FCA incentivizes potential whistleblowers to bring qui tam actions against individuals or businesses committing nursing home fraud by offering a financial reward if the whistleblower’s lawsuit is successful. Under the FCA, qui tam relators whose tips lead to the government successfully recovering defrauded funds are entitled to between 10 and 30 percent of the total amount that is recovered.
In addition, whistleblowers are protected from employer retaliation under the FCA. Specifically, whistleblowers are protected from any form of discrimination directed at them for their actions as a whistleblower, including termination, demotion, suspension, withholding pay or benefits, and harassment.
Reach out to a Nursing Home Fraud Attorney in Chicago
The whistleblower attorneys of Tycko & Zavareei LLP are dedicated to helping whistleblowers across the country shed light on unethical business practices and have been nationally recognized for their efforts to fight fraud. Our nursing home fraud lawyers work solely on qui tam cases and are committed to helping whistleblowers earn the maximum potential compensation if their case leads to a successful recovery.
At Tycko & Zavareei LLP, our Chicago nursing home fraud lawyers have worked on cases that have resulted in the recovery of millions of dollars, including a healthcare kickback case that settled for $350 million. If you have proof of nursing home fraud or other healthcare facility fraud in Chicago, contact the lawyers of Tycko & Zavareei today for a free confidential case evaluation.
