DOJ Targets Skilled Nursing Facilities for FCA Violations

Every year, the United States Department of Justice (DOJ) announces its priorities, in part to inform the public about its activities, but also to put potential wrongdoers on notice that they will be under extra scrutiny. The announcement also is intended to make otherwise recalcitrant people comply with the law, which both protects the public and reduces the likelihood of getting targeted in an investigation. This year, among its other priorities, the DOJ has announced it will be focusing on violations of the False Claims Act (FCA) by skilled nursing facilities.

The FCA is the federal law that makes it illegal for people and companies to defraud the government, such as through Medicare, Social Security, scientific grants, or military contracts. Specifically, it allows the government to bring civil action against anyone who fraudulently makes a claim for government funding or reimbursement they are not legally entitled to. Crucially, the FCA also has a qui tam “relator” whistleblower provision, which allows a whistleblower at a company to sue on the government’s behalf to stop fraudulent behavior.

Right now, enforcement of the FCA is heavily reliant on these qui tam whistleblowers, with more than 70% of enforcement actions brought on that basis. The DOJ is looking to step up its own efforts in prosecuting FCA violations, particularly at skilled nursing facilities. Disturbingly often, skilled nursing facilities will file claims for unnecessary medical procedures for patients with Medicare or Medicaid, or file claims with improper coding that triggers greater reimbursement from insurers. On rare occasions, they may even file claims for procedures or tests they never performed. These claims cost taxpayers tens of millions of dollars every year, and put patients’ lives at risk by placing profit over care.

If you or a loved one has suffered an injury or illness due to the negligent conduct of a skilled nursing facility, such as dehydration, bed sores or other symptoms of abuse, it’s important to get the legal representation you need to remedy the situation and get compensation for the harm you and your loved ones have suffered. The lawyers at Levine and Slavit, PLLC are experienced in representing New York City and Long Island residents in medical malpractice. To schedule a free consultation, contact our New York City medical malpractice lawyers at (212) 687-2777 or for our Long Island medical malpractice lawyers call (516) 294-8282.

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