Medicare fraud within Assisted Living Facilities across the country. As more facilities take advantage of the system, it’s important to know how to spot the various forms of fraud that can occur in these settings.

Identifying nursing home and assisted living fraud crucial in ensuring that beneficiaries receive the care they deserve and that taxpayer dollars are not being misused.

In this blog, we discuss specific actions that occur in nursing homes and assisted living facilities that can be considered Medicare fraud. We also provide you with guidance on how to spot and report these types of fraud if you experience them.

What Constitutes Medicare Fraud in Assisted Living Facilities?

While fraud can exist in many forms throughout the healthcare sector, here are just a few of the most common types of fraud you should look for in assisted living facilities.

  • Switching

This type of fraud involves switching patients without consent or the ability to consent from Medicare Part C “Managed Medicare” to Medicare Part B “Traditional Medicare” purely for financial gain.

  • Incorrect Coding

This type of fraud occurs when healthcare providers use incorrect codes to bill Medicare for services or procedures that were not actually provided to the patient. This can include “upcoding” or billing for more expensive procedures or services than were actually performed or using codes that do not accurately reflect the level of care provided.

  • Ordering Excessive Diagnostic Tests

Ordering unnecessary or excessive diagnostic tests is another type of fraud that can occur in assisted living facilities or nursing homes. Healthcare providers may order unnecessary tests to increase billing, even if the tests do not provide any meaningful benefit to the patient.

  • Changing Rehab Progress Reports

Altering or falsifying rehab progress reports is another type of fraud. Providers may manipulate or falsify contracted rehabilitation reports to justify the need for more therapy or services than the patient actually requires, resulting in increased billing.

It is important for medical office staff to be aware of these types of fraud that can occur in assisted living. By understanding these fraudulent activities, staff members can help identify and report suspicious billing practices and protect Medicare from fraud.

If you suspect fraud, it is important to report it to ensure that those responsible are held accountable and that beneficiaries continue to receive the care they need.

How to Report Medicare Fraud in either an Assisted Living Facility or Nursing Home

If you work in a facility and suspect that fraud is occurring, or if you have been asked to commit a fraudulent act as part of your duties, know that it’s okay to come forward.

DJO Whistleblower Law Group is here to help you every step of the way. If you have information that can help bring Medicare fraud and/or Long-Term Care Fraud to light, here’s how you can help expose it.

  • Gather Information & Evidence
  • File a Claim. A whistleblower must file a qui tam complaint in court and submit it to the government, that details the alleged fraud. Our law firm will assist you in submitting all paperwork necessary for filing your report.
  • Investigation. The government will examine your evidence, review your documents and may also request additional documents relating to the alleged fraud. During this time, we’ll be by your side to make sure you provide whatever information the government requests. We’ll also be there to remind you not to discuss your case with anyone while it’s under seal.
  • Stay Vigilant & Safe. After the government investigates, it will decide whether it wants to bring formal legal action against the accused. If the government does decide to intervene and take over the prosecution, the case will then proceed through the process of litigation or settlement.
  • Earn a Significant Reward. Whistleblowers who bring original information to the government can be entitled to receive a share of the government’s recovery. An individual (called a false claims plaintiff or relator) who is an original source of information can sue for violations of the False Claims Act. If the government prosecutes, a relator can receive up to 25% of the total amount recovered.

Throughout the entire whistleblowing process, we’ll advocate for your rights and provide counsel for navigating the arduous but rewarding process of shedding light on fraud.

Doing What’s Right

We understand that identifying and reporting fraud can be a daunting task, but with the right information and support, you can make a difference in protecting the integrity of the Medicare.

As a law firm that helps people report fraud to the government, DJO Whistleblower Law Group is committed to supporting you in your efforts to combat fraud.

We are comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can expose fraud.

If a whistleblower’s lawsuit is successful, the reward can be up to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

Do you have valuable information that can help bring Medicare fraud to light? Speak to our experts today.

authored by Christopher J. Piacentile
Director of Investigations DJO Whistleblower Law Group

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