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Historic Settlement Highlights Risk Of Financial Exploitation In Nursing Homes

When we think of nursing home abuse, we usually think of seniors being physically harmed. We may think of mental, emotional or even sexual abuse. And we think along those lines for good reason - those forms of abuse are real, and they can have devastating effects on victims and their families.nursing home

But nursing home residents are also vulnerable to another form of abuse, one that can be just as devastating: financial exploitation.

This issue has been in the news recently as the Department of Justice settled a lawsuit against a major, nationwide provider of skilled nursing services for billing for unnecessary services.

Lawsuit alleged that provider, owner used fraudulent scheme for financial gain

According to the lawsuit, Life Care Centers of America Inc., a Tennessee-based company that owns and operates more than 220 nursing facilities nationwide, systematically submitted false claims for rehabilitation therapy in order to bill Medicare and Tricare for additional reimbursement. Among the alleged abuses were placing patients in high levels of skilled therapy irrespective of their actual clinical needs and keeping patients in those highly skilled rehabilitation therapies longer than was necessary - even when their own therapists believed the services should be discontinued - in order to bill the government for those additional services.

The government's suit also alleged that Forrest L. Preston, the owner of Life Care, used this fraudulent scheme for his personal enrichment.

Life Care agreed to pay $145 million to settle the lawsuit, which also includes a five-year Corporate Integrity Agreement in which an independent review organization will assess whether Life Care's therapy services are appropriate and medically necessary.

Billing for unnecessary services is a common form of nursing home abuse

Family members bring their loved ones to a nursing home or rehabilitation facility trusting that the facility will provide services based on the resident's individual needs. However, in too many cases, these facilities prioritize their financial self-interest rather than their duty to care for patients.

In many cases, such as the Life Care case, this means the facilities push unnecessary treatments onto patients, or keep patients in care for longer than is medically necessary. Other forms of financial exploitation include:

  • Billing for services not actually provided.
  • Double-billing for services.
  • Charging unreasonable fees for services.
  • Prescribing (and charging for) unnecessary medication.
  • Cashing checks without the resident's authorization.

Sometimes, as in the Life Care case, it's Medicare or an insurance provider that ends up footing the bill for financial exploitation. But even then, the effects on the resident and his or her family can be profound. Financial exploitation is a violation of trust committed by people who are supposed to be trustworthy caregivers. Patients may feel guilty, ashamed, angry or worthless after being the target of a financial scheme, even leading to the development or worsening of emotional disorders in some cases.

And in too many cases, it's the resident - or his or her family - who is hurt financially as well as emotionally.

Whether it happens on a small scale or nationwide, financial abuse of nursing home residents is never acceptable. But proving that exploitation has occurred and holding the negligent nursing home accountable can be very difficult. That's why it's so important to have an experienced nursing home abuse attorney on your side.

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