On February 8, 2012, Bloomberg News reported that fourteen hospitals in New York are paying $12 million to settle the allegations that they made false claims to Medicare. Beginning in 2000, and for eight years thereafter, these hospitals overcharged Medicare for kyphoplasty surgeries that were performed on osteoporosis patients with spinal injuries.
As shocking as this may sound, similar fraud against Medicare occurs quite often. Just recently, a total of about forty hospitals have paid $39 million for similar cases of overcharging Medicare. Sometimes, these false claims are referred to as “upcoding” because the healthcare facilities upcode their patients’medical conditions, so that they can report a higher reimbursement rate.
Just a month ago, the federal government investigated another case in which pharmaceutical companies were manipulating their financial statements in order to profit from government health programs. You can learn more about this case and the incentives pharmaceutical companies and other healthcare businesses have to cheat Medicare by reading this California Nursing Home Abuse Blog.
Some skilled nursing facilities cheat government health programs for reasons other than to profit. For example, some facilities use Medicare or Medi-Cal money to order antipsychotic drugs that were never prescribed by a physician in the first place. These drugs are usually used as chemical restraints, to sedate dementia patients who have episodes of aggravation. However, studies have shown that the use of chemical restraints actually worsens aggravation and also makes patients twice as likely to die from an overdose. Furthermore, the use of restraints can not only lead to death, but is also a direct violation of the Patients’ Bill of Rights. The use of restraints is most commonly found in nursing homes that are understaffed and unable to personally attend to each patient and provide him or her with the individualized care that he or she needs.
In an attempt to stop fraud against the United States government and to encourage witnesses of such fraud to speak up, the federal government passed the False Claims Act, which states that whistle-blowers can sue on behalf of the government and receive a share of any claims that are made. This further proves how serious fraud against the government is, especially when the lives and well-being of nursing home residents are being put in danger.
Here at the Yeroushalmi Law, we can help you with the legal aspects of nursing home neglect and fight for the rights to which your loved one is entitled. Contact us today for a free consultation.