Nursing Home Owner CONVICTED in $1.3 Billion Health Care Fraud Case - Terry Law Firm

Nursing Home Owner CONVICTED in $1.3 Billion Health Care Fraud Case

Nursing Home Owner Convicted in Largest Health Care Fraud Scheme Ever

Medicare and Medicaid fraud are serious problems.  It hurts all of us, whether we are actively using those benefits now or expect to be in the future.  One South Florida health care facility owner was alleged to have racked up $1.3 billion in fraudulent claims drawing the attention of the United States Department of Justice.  According to the Department of Justice news, last week after an eight-week trial the Florida nursing home owner was convicted of several charges, including conspiracy to defraud, receipt of kickbacks, money laundering, bribery, and obstruction of justice.  The Department of Justice alleged that he defrauded Medicare and Medicaid over $1.3 billion while also providing sub-standard medical care and treatment to patients.

This case made the news because of the enormity and brazenness of the alleged fraud, but lest you think this is just a problem in Florida, I can assure you that this same thing is most likely happening right here in Missouri. People don’t want to believe that nursing home owners could purposefully provide substandard care to vulnerable, elderly people in order to “pad their own wallet” but they do. And worse yet, sometimes they even commit fraud to make even more money for themselves.  This is not an isolated incident nor is it something that just happens somewhere else… it is happening right here in Missouri nursing homes.

Facts Associated With One of the Largest Health Care Fraud Schemes Ever

According to written reports, the nursing home owner at issue in Florida had an elaborate network of nursing homes, assisted living facilities, and related rehabilitation facilities that he owned.  From approximately January 1998 through July 2016, he bribed physicians to admit patients into his facilities and then cycled residents through the numerous facilities.  On the residents’ journey throughout his facilities, he would bill for a litany of medical services that were never performed or for medically unnecessary services.  These were billed to Medicare and Medicaid, which paid for the services.

However, the Department of Justice alleged that the medical services that were performed for residents were performed in a sub-standard manner and that the nursing home facilities themselves were also substandard.  Numerous witnesses testified at trial that the health care facilities had poor conditions and inadequate care.  But reportedly the Florida owner was able to avoid some of the heavier fines  because he  bribed an employee of the Florida state regulator so he could get advanced notice of surprise inspection at his facilities.  Apparently, once he had notice of an upcoming inspection, he would  quickly bring the facilities up to standard for the inspection.

The government alleged and apparently proved, according to the article by the Department of Justice, that this particular owner was able to generate more than $37 million for himself, which lead to a life of luxury automobiles, watches, and other extravagant purchases.  Several other co-conspirators, including a physician’s assistant, were also charged but plead guilty.

How Does this Happen and Why it is More Widespread Than Just This Case

Far more nursing home owners live lives of luxury than people would ever expect. Despite the nearly universal claims of poverty from the nursing home industry, most of them are making substantial amounts of money.  Here at the Terry Law Firm, we don’t have any problem with nursing homes being profitable or owners leading a nice life as a result of a moral and ethical business model.  That is what capitalism is and we support that.  The problem is when nursing home owners place their own profit and grand lifestyle above the needs of the residents. When greed takes over, it becomes more probable that owners will cut corners with staffing levels which leads to higher profit but less quality care. While Medicare and Medicaid fraud on the level at issue in the Florida case is rare, it is much more common that most people think. This problem can (and does) happen anywhere and everywhere, even right here in Missouri. Greed and fraud  is not isolated to this one Florida nursing home owner.  

And guess who a nursing home owner is stealing from when he defrauds Medicare and Medicaid?  YOU, the taxpayer!

Key Warning Signs From One of the Largest Healthcare Fraud Schemes Ever Through Nursing Homes

There are many components of this case that are present in many other nursing home facilities, including right here in Missouri.  Although many nursing home companies follow the law, some ignore or even break the law for their own personal benefit.  Not only is this illegal and harmful to the residents, but it is actually a warning sign that there are other problems at the facility than billing fraud.  

For instance, it appears that many of the facilities involved in the Florida case were not only defrauding the government, but they were failing to provide proper services to residents, leaving residents in unsafe or dangerous environments, and routinely providing poor care to residents.  If a healthcare facility is willing to lie to the government, what are they willing to say or do to a resident or that resident’s family member, especially a resident who is elderly, sick, ill, and otherwise vulnerable?   

Be wary of what nursing homes tell you. Many nursing homes will promise terrific care and personalized service, yet few actually live up to those promises. Many nursing homes will say just about anything to make money. Again, while most nursing homes are not defrauding the government of millions of dollars, they may not be providing quality care either. To that end, it is important to know these key warning signs of healthcare facilities which you may want to avoid: Some of these warning signs include the following:

  • Multiple facility transfers;
  • Poorly kept facilities, even just the outside like the siding, roofing, and landscaping is a sign that the inside is much worse;
  • Lack of staff and understaffing;
  • Notices from Department of Health and Senior Services that claims, treatments, or other care was denied;
  • Poor explanation why certain services are being rendered, or not rendered, to your loved one;
  • Lack of visibility of an administrator or owner;
  • Majority of residents are referred by the same doctor;
  • Repeated health violations;
  • Disciplinary record of an administrator or owner, including in other states; and
  • Other serious factors.

Health Care Fraud Hurts Us All, Including Residents of Missouri Nursing Homes

If your loved one is in a Missouri nursing home facility that has multiple citations or is under investigation for health care fraud, it is highly likely that there are more problems that may affect the you’re your loved one is receiving.  If your loved one has suffered any harm while in a health care facility in Missouri, including physical, emotional, sexual, or financial abuse, please call our St. Louis nursing home abuse and neglect lawyer for a FREE consultation to learn what your rights to compensation may be.  You can reach us directly at (314) 334-1439.

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