by Brian Mahany
The front page headline of today’s Wall Street Journal says it all – “As America Ages, Shortage Of Help Hits Nursing Homes.” The fastest growing segment of America’s population are baby boomers and they are starting to hit their mid 60’s. As the demand for nursing home beds increases, the amount of skilled workers to operate those facilities is waning. Medicare reimbursement has not kept pace with rising health care costs either. Add those ingredients and you have the perfect recipe for cutting of corners and fraud.
According to the WSJ, pay for nursing home workers is quite low, often less than $12.00 per hour. The work isn’t very glamorous or easy. Plus it can be physically demanding. Many of the patients requiring skilled care are not ambulatory and need to be lifted several times per day.
Federal and state law require minimum staffing guidelines but don’t offer much money to help the majority of homes that accept Medicare patients. The result is a huge temptation to submit fraudulent billings and bill for staff that isn’t actually on the floor or tasked with patient care.
A frequent scam is to certify that more nurses or skilled workers are on the floor than are actually present. Unfortunately, when that happens, its usually taxpayers that foot the bill. Medicare and Medicaid are government health care programs that rely on tax dollars.
The FBI estimates that health care fraud costs our economy $80 billion per year.Defrauding taxpayers is bad enough but using improperly trained nursing home workers or having insufficient staff threatens lives. Poorly run nursing homes also have higher instances of patient abuse.
Last year jurors in Georgia convicted George Hauser for Medicare fraud. Prosecutors say that despite receiving $32.9 million in federal funds, residents in Hauser 3 nursing homes often didn’t have food, heat or air conditioning. Rodents, mold and mildew were everywhere.
Unfortunately, stories like this are repeated every month across the United States. And how do these fraudsters get caught? Often by whistleblowers; concerned employees who refuse to ignore the rampant fraud caused by dozens of nursing home and other health car providers.
Whistleblowers are the true American heroes. Their actions save taxpayers billions of dollars every year and in the case of health care fraud, often save lives and prevent needless suffering.
The false claims law allows whistleblowers to receive a percentage of whatever is recovered from the fraudsters. Some whistleblowers have received tens of millions of dollars. With health care fraud measured in the billions, plenty more whistleblowers are needed.
To become a whistleblower, you must first possess inside information. Information gleaned from a newspaper is not what the courts call “original source.” If you have information about a fraud, speak to a lawyer specializing in whistleblower cases. He or she can help you file a complaint in federal court and work with the involved state or federal agencies to investigate your claim. While the matter is under investigation, the case is “sealed,” meaning your identity is kept confidential.
For more information or to learn if you may qualify for a cash award, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries are kept in strict confidence and protected by the attorney – client privilege.
Mahany & Ertl – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan; Minneapolis, Minnesota; Portland, Maine and San Francisco, California. Services available in many jurisdictions.
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