At a recent conference, a senior Department of Justice (DoJ) official announced areas of fraud that the DoJ plans to target in 2020 under the False Claims Act (FCA). One of these areas is Medicare fraud in nursing homes.
So far in 2020, the DoJ has announced two large settlements in this vein. In the first settlement, the government recovered nearly $15.5 million and awarded the whistleblower $2.8 million for bringing the alleged fraud to light. In the second case, the government recovered $9.5 million and awarded two whistleblowers $1.4 million and $145,350 respectively.
Medicare fraud in nursing homes can arise under several fact patterns. Nursing homes may inflate the care needs of their residents in order to bill Medicare and other government health programs at higher rates. They may also provide and bill for services that are not medically necessary. The DoJ appears highly motivated to take on these cases and assist whistleblowers recover public funds.
The claims and settlements discussed above are allegations only. There has been no determination of liability.