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Nursing Homes Not Following COVID-19 Guidelines? Whistleblowers May Be Able to Earn a Reward

Federal laws and regulations require nursing homes and assisted living facilities to take special precautions to protect residents against the coronavirus pandemic. When nursing homes fail to follow these safeguards, they are putting their residents at a greater risk of harm, and in many cases, defrauding Medicare out of money by falsely claiming that they have complied with federal laws and regulations.

Individuals who are aware of such fraud can file a lawsuit under the False Claims Act on behalf of the United States.  If the lawsuit is successful, a whistleblower can be entitled to a significant amount of money.  More importantly, the whistleblower can put an end to a nursing home’s dangerous practices and punish a nursing home company for its corporate greed.

Who can be a whistleblower?

Anyone who is aware of fraud being committed by a nursing home or assisted living facility can report it as a whistleblower under the False Claims Act.  Typically, a whistleblower will be an employee of the nursing home such as a doctor, nurse, or someone who works in the billing department.  A whistleblower can also be a family member who has become aware of unsafe practices at a particular facility.  The important thing is that the individual has specific information concerning the fraud.

How do I know if a nursing home is defrauding Medicare?

Medicare pays for the medical care of most nursing home residents due to their age.  When a nursing home company seeks reimbursement from Medicare for a resident’s care, it has to certify that it complied with all federal laws and regulations.  If the nursing home did not follow all of the laws and regulations but certified to Medicare that it did, it has committed fraud against the government.

One law passed by Congress is the Nursing Home Reform Act.  This law requires nursing homes to “provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in accordance with a written plan of care.”  In the wake of the coronavirus pandemic, the federal government has also implemented standards for nursing homes to meet in an effort to protect residents.

One important directive from the federal government is for nursing homes to restrict visitation of all visitors and non-essential health care personnel.  Directives also include, but are not limited to, using face masks and gloves, canceling group dining and activities, isolating residents with coronavirus symptoms, screening residents and staff for respiratory symptoms, instructing visitors on proper handwashing and to avoid touching surfaces, and closely monitoring staff members who work at multiple facilities.

When the care provided by nursing homes is grossly substandard due to the failure to meet these directives, the nursing home likely violated the False Claims Act by falsely certifying to Medicare that it had provided adequate care.

How do I report a nursing home for coronavirus violations?

Reporting fraud as a whistleblower is a step-by-step process. If an individual is aware that a nursing home is not providing its residents with adequate protection against COVID-19, he or she can file a lawsuit against the nursing home under the False Claims Act.  This type of lawsuit is filed by a whistleblower but is brought on behalf of the United States. The first step in filing a lawsuit is to contact an attorney that is experienced in suing nursing homes under the False Claims Act.

A False Claims Act attorney will want to know the details of the nursing home’s practices which are putting residents at risk.  The attorney will then put together a case and present the case to federal prosecutors before filing a lawsuit in federal court.  The lawsuit is filed under seal which gives the government time to investigate the nursing home’s fraud.  If the government believes that the case merits prosecution, it will intervene in the case and take over litigating the case.

How much can a whistleblower earn?

If the nursing home agrees to settle a False Claims Act lawsuit, or if a jury finds against the nursing home at a trial, the whistleblower is generally entitled to 15 to 30 percent of the amount recovered by the Government.  The exact amount depends on whether the government intervened in the case as well as the extent of the whistleblower’s assistance.  In some cases, this means that a whistleblower can earn millions of dollars for simply filing a lawsuit and alerting the government to a nursing home’s dangerous practices.