Healthcare Abuse and Fraud

Healthcare abuse and fraud costs billions of dollars every year. Nursing home residents are particularly vulnerable to this type of abuse.
healthcare abuse and fraud

Healthcare abuse and fraud in nursing homes cost the healthcare system billions and put residents at risk.  Nursing home administrators and staff have a legal obligation to protect residents from personal identity or medical records theft, withholding medication or overmedicating and other forms of mistreatment that occur where nursing home fraud takes place.

If you suspect that a nursing home resident is affected by healthcare abuse or fraudulent billing practices, help is available.  Call 1-866-548-9636 today for a free case consultation. Learn more about your rights and what you can do if you suspect fraud.

What is Healthcare Abuse and Fraud in Nursing Homes?

Healthcare abuse and fraud is the practice of improper, inflated or otherwise unlawful medical billing.  Medicaid, Medicare and private insurers who fund the care of nursing home residents are vulnerable to fraud.  When it happens, residents are inevitably affected.  In nursing homes, healthcare abuse and fraud includes:

  • Phantom billing – Where a nursing home bills for services or care that is either unnecessary or not performed.
  • Double billing, upcoding or upbilling – Billing includes more procedures or supplies that are more expensive than those performed or used.
  • Billing for medically unnecessary goods or services.
  • Billing for non-covered goods or services.
  • Providing kickbacks in exchange for unused drugs or medical records.
  • Managed Care Providers billing Managed Care Plans for medically unnecessary services.

Federal and state agencies investigate complaints of Medicare and Medicaid fraud, in addition to proactively seeking out offenders to bring them to justice.  These agencies can use the Medicare Fraud Strike Force and the criminal justice system to punish those who commit healthcare fraud and deter others from participating.  However, these systems do not provide compensation for elderly victims in nursing homes who have been adversely affected.

If you suspect that you or a loved one are suffering mistreatment, abuse or neglect in a nursing home, you do not have to fight the system alone.  Call 1-866-548-9636 to learn more about how you can protect nursing home residents from healthcare fraud and abuse.

Who Does Healthcare Abuse and Fraud Affect?

The perpetrators of healthcare abuse and fraud may feel that the amount of money they are inappropriately billing is just a small drop in the huge national healthcare spending bucket. 

healthcare abuse and fraud

However, Medicare and Medicaid fraud are the most prevalent form of insurance fraud in the United States.  Experts estimate that fraud adds roughly 10% to annual Medicare and Medicaid spending.

Healthcare abuse and fraud in nursing homes is more than a simple financial crime.  The impacts and harmful effects on vulnerable nursing home residents can impact the victim’s quality of life, emotional well-being and physical health.

How Are Nursing Home Residents At Risk?

Nursing home residents are already among the most vulnerable members of society.  Due to their physical limitations, cognitive issues and other conditions, they may be reliant on nursing home staff for meals, medication and personal care.

This puts nursing home residents at risk of all kinds of mistreatment by those involved in healthcare fraud.  These are just a few of the ways healthcare abuse and fraud affects victims:

  • Stolen medical records provide information that identity thieves can use to obtain controlled prescription medications.
  • Nursing home residents may be pressured by pharmacists, nursing home staff or others on whom they rely for access to medication to sell their personal information in exchange for kickbacks. This forces them to participate in the crime.
  • Staff members may succumb to bribery to sell unused drugs. This incentivizes withholding medications from residents who need them.
  • Nursing home resident medical records may be falsified to justify fraudulent billing, which can endanger the patient’s care and even their life in the future.
  • Residents are at risk of unnecessary procedures and medications being imposed upon them to justify fraudulent billing.

Nursing home staff and other service providers who work inside nursing homes are in the best position to detect and report healthcare abuse and fraud.  However, these people also understandably fear the potential repercussions of reporting their employer to federal or state regulators.

Call Fight Nursing Home Abuse now to learn more about your rights and responsibilities in cases of healthcare abuse and fraud in nursing homes. Call us toll free at 1-866-548-9636. 

What Compensation is Available to Nursing Home Residents Affected by Healthcare Abuse and Fraud?

Healthcare abuse can have a severe and long-lasting impact on its victims.  In the most severe cases, wrongful death can result from nursing home fraud.  For example, a resident whose medical records have been falsified to justify billing for an opioid medication is vulnerable to having that medication administered by other medical professionals with good intentions.  Where a resident is allergic to the drug or has other prescriptions or medical conditions that are contraindicated, the reaction could be fatal.

When a loved one dies due to healthcare abuse, a law firm can help families secure compensation. Compensation may include funeral costs, burial or cremation expenses, pain and suffering experienced before death and more.

If you have experienced the detrimental effects of healthcare abuse and fraud in nursing homes, compensation may be available for:

  • Pain and suffering
  • Therapies, counseling, rehabilitation, or other services required as a result of the abuse
  • Moving you to a safe facility for your security and well-being
  • Financial losses sustained as a result of the fraud
  • Emotional anguish
  • Proper medications, adaptive equipment, mobility aids, and other medical supplies denied to you as a result of the fraud

Contact a Nursing Home Abuse Law Firm

If you or someone you love is suffering from healthcare abuse and fraud, you should know that you are not alone.  At Fight Nursing Home Abuse, we help victims and their families understand their legal rights.  We also explain the options available to them for obtaining justice. 

While we know that you feel overwhelmed, help is just a call away. Call 1-866-548-9636 to request a free consultation with our nursing home abuse lawyer.

meagan cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to FNHA and our websites, including Birth Injury Guide and