How To Use The False Claims Act To Prevent Nursing Home Fraud And Patient Abuse

Frank Bailey

Attorney
(866) 735-1102 Ext 435

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As the baby boom generation moves from middle age to retirement, tens of millions of Americans will be entitled to Medicare benefits. Nursing home care and home health care are two of the fastest rising areas of Medicare spending.

It has been estimated by the General Accounting Office (GAO) that as much as 10 percent of the federal budget is lost to fraud and abuse. The Federal False Claims Act, with its "qui tam" provision, has become one of the primary means the government has for fighting fraud in the Medicare, and Medicaid programs.
The False Claims Act, sometimes referred to as "Lincoln's Law," was passed at the urging of President Abraham Lincoln in 1863 to combat the fraud being perpetrated on the Union by profiteers selling shoddy, defective, or nonexistent goods. The act provided that the individuals who provided information were compensated by receiving bounties of up to 50 percent of the money the lawsuit recovered for the Treasury. This bounty or "qui tam" was the reward given whistle blowers for information.
The Congress amended the Act in 1986 to provide successful qui tam plaintiffs at least 15 percent and up to 30 percent of the funds they help recover from the defendant.
The latest figures show in 1998, that 60 percent of the cases involved health care. In 1998, the government filed 472 cases and recovered 394 Million dollars for false claims. On average, the amount paid by the government to individuals who provided information as their share has been 17 percent.
A small but growing number of cases have been b brought under the False Claims Act alleging fraud in the context of nursing home care, either by improper billing for supplies, unnecessary care, and more recently, substandard care.
We can all help our government by coming forward with information we have concerning Medicaid or Medicare fraud. A personal injury attorney can help review the case and direct the "whistle blower" in the proper channels.