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Healthcare fraud may constitute nursing home abuse

Healthcare fraud may not be what immediately comes to mind when people in North Carolina discuss nursing home abuse, but it is a serious and growing issue. Generally, the healthcare fraud engaged in by nursing homes involves illegal, inflated or improper medical billing. Residents in nursing homes who get funding from private insurance, Medicaid or Medicare are more vulnerable than others to fraud. When such fraud happens, it can have serious negative effects for the resident.

Some common healthcare fraud strategies include overbilling by including more supplies or services than the resident actually utilized, billing for services or items that the payor organization does not cover, and billing for things that are not medically necessary. Other common techniques include offering kickbacks for unused drugs and billing for unnecessary care or other services.

Nursing homes that do not have sufficient staff working may be at a higher risk of abuse. Healthcare fraud affects the residents of the nursing home as well as the insurance-buying public. Residents can be impacted by having to go through unnecessary procedures, by identity theft due to the sale of medical records or by having inaccurate medical records due to fraudulent record keeping.

The staff and service providers at nursing homes are often the best equipped to spot nursing home abuse. They are also among the least likely to report it because of a reluctance to challenge and potentially harm their employers.

An attorney with experience handling nursing home neglect or abuse cases might be able to help interested parties pursue relief for fraud or other violative actions. An attorney might examine the facts of the case and render an opinion as to the causes of action available or the likely outcome. The attorney might then draft and file the documents necessary to bring a claim or negotiate a settlement with at-fault parties.

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Daniel Pleasant Holoman LLP

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