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Nursing Home Fraud

The administrative rules and laws that govern nursing home billing practices are constantly changing. As a result, many of those who are accused of nursing home fraud are simply conducting business as usual and are unaware that a significant change in law or policy has occurred. Having the advice of an experienced attorney can be crucial to the outcome of a case, so if you are being investigated for fraudulent activity, it is critical to contact a white collar crime attorney who can explain your legal options and help you formulate a defense.

Types of Nursing Home Fraud

A number of different activities fall under the broad category of nursing home fraud. However, the most common include:

  • Fraudulent billing practices;
  • Medicaid and Medicare fraud;
  • Alteration of documents; and
  • Improper insurance collection.

Billing Practices

The nursing home billing process is complicated, which can lead to mistakes that could qualify as fraudulent activity. Many allegations of nursing home fraud stem from claims of fraudulent Medicaid billing practices. Medicaid fraud occurs when a Medicaid provider knowingly makes false statements to obtain reimbursement from the program. Nursing homes are most commonly investigated for claims of the following billing practices:

  • Billing for goods and services that were not provided;
  • Billing for “phantom” patients;
  • Double billing;
  • Billing for more expensive procedures than were actually performed;
  • Billing for medically unnecessary goods or services;
  • Billing for multiple services that should have been combined into one billing;
  • Billing Medicare or Medicaid for non-covered services; and
  • Taking illegal kickbacks in exchange for referrals.

Being convicted of these types of fraudulent activities can result in hefty fines, mandatory restitution, and even jail time.

Preventive Measures

To help avoid even the appearance of wrongdoing, it is important for nursing home staff to institute certain practices. Those who take the following steps may be able to prevent accusations of fraud:

  • Keeping clear and accurate billing records;
  • Ensuring that the billing department is strictly monitored;
  • Hiring qualified employees to handle billing issues;
  • Staying up-to-date on new administrative regulations and policies;
  • Ensuring that employees are regularly trained on proper billing practices; and
  • Keeping patients and family members notified about the services they are receiving and how they will be billed.

Although taking these steps does not guarantee that a nursing home will not ever be accused of fraud, it can go a long way towards ensuring that any allegations can quickly be dismissed.

Contact us Today to Speak With an Experienced White Collar Crime Attorney

Nursing home fraud charges can have devastating consequences for defendants, many of whom may not have been aware that their practices were illegal. For this reason, it is critical for those who are being investigated for nursing home fraud to speak with an experienced attorney who may be able to get their charges reduced or even dismissed. If you are being investigated for nursing home fraud, please contact the Miami law firm of Jeffrey S. Weiner, P.A., Criminal Defense Attorneys by calling (305) 670-9919 to schedule a free consultation with a dedicated white collar crime attorney. We can also be reached via live chat and by completing and submitting one of our brief contact forms.



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