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Nursing Home Fraud

When a 98 year-old woman entered a nursing home several years ago, her family dreamed that she might return to the assisted-living facility that she had called home for many years.  Unfortunately, unable to walk and suffering from dementia, she had reached a point where she needed around-the-clock care.   At the nursing home, her condition worsened, and she contracted an infection that caused diarrhea and required isolation from other residents.  After five weeks, she passed away at the nursing home.

Despite her condition, her records show that she was receiving more than 5 hours of therapy per day.  On the day that she passed away, the nursing home claims that she received more than 2 hours of therapy.  If you’re thinking that doesn’t make sense, you’re right. Here at the Jehl Law Group, we see nursing homes committing fraud like this all too often.  We have seen nursing homes bill for therapy and other services that they don’t actually provide.

Earlier this year, Kindred Healthcare Inc. and two of its subsidiaries agreed to pay the federal government $125 million to settle an ongoing fraud lawsuit. Kindred Healthcare Inc. is one of the larger nursing home chains in the country, and the government alleged that they were fraudulently billing for unnecessary therapy services. Life Care Centers of America, another large nursing home chain, is also being sued for these same practices.

What kind of therapy do nursing homes provide? Physical, Speech, and Occupational Therapies are the most common forms of therapy provided at nursing homes. These therapies can have huge benefits for some residents.

Then why would a nursing home pretend to provide therapy to some residents? Money.  Medicare reimbursements for therapy are one of the largest funding sources for nursing homes. The more therapy that nursing homes provide or claim to provide; the more money they receive from the government. There are five levels of therapy for residents, and nursing homes receive more funding for each level:

  • Low: 45-149 minutes of therapy per week, receiving therapy at least 3 days per week.
  • Medium: 150-324 minutes, receiving therapy at least 5 days per week.
  • High: 325-499 minutes. One specific discipline (i.e. speech, physical, or occupational) at least 5 days per week.
  • Very-High: 500-719 minutes. One specific discipline at least 5 days per week.
  • Ultra-High: Over 720 minutes. At least two disciplines of therapy and one of them has to occur at least 5 days per week.

In our case, the nursing home claimed that a 98 year old woman who was unable to walk and suffering from dementia was receiving ultra-high therapy with 875.6 minutes of therapy per week.

How do they do it? Nursing homes can use a variety of methods to increase therapy levels fraudulently. These are some of the most common that we see here at the Jehl Law Group:

  • Some nursing homes may report that therapy was provided even when the patient was asleep, unable to complete therapy, or sometimes absent from the nursing home altogether.
  • Some nursing homes may continue providing therapy services even though therapists have recommended that the resident no longer needed therapy.
  • “Skilling” or “ramping”: Nursing homes are not required to disclose the therapy hours that a resident receives every week. Instead, they do a week-long assessment and submit that information to the government.  The government then uses that information to determine how much to reimburse the nursing home.  To trick the government, nursing homes may “skill the patients” by “ramping” up the therapy hours that they receive during that initial assessment period. As soon as the assessment period ends, the nursing homes will then stop or decrease the therapy hours that residents are receiving. Nursing homes may not notify the government of the decrease, so they keep getting paid for services that they are not providing to residents.
  • Some nursing homes may not even bother with those initial assessments, and instead they will just place all residents into the highest therapy levels so that they receive the highest amount of money from the government. In doing this, they would disregard the actual needs of the resident.

If you think you or a loved one is receiving unnecessary therapy services or inadequate care, do not hesitate to contact us at the Jehl Law Group. We have attorneys with years of experience exposing the abusive, neglectful, and fraudulent practices of nursing homes.