Nursing home facilities could face fraud charges due to the nature of their work. If you own such a facility, you should be cautious about every decision you make to avoid getting into legal trouble.
Here are two elements that can lead to nursing home fraud:
Errors in charges billed to Medicaid
Billing Medicaid for services that were not rendered or overbilling for services can result in a nursing home facing fraud charges. This can also happen when a facility sends a bill for more expensive or complex procedures that were not performed, instead of what was actually performed (upcoding). Cases of nursing homes facing fraud charges because they billed Medicaid for services not covered by the program by falsely classifying them as medically necessary have also been reported.
Any mistake your employees make when billing can lead to an investigation of your facility. For example, an employee may use the wrong codes, resulting in overpayments, which can raise questions. Further, while failing to properly document services can be seen as a mistake that often leads to a claim denial, Medicaid can also view it as a tactic to hide a fraudulent activity.
Ensure your employees are well-trained on billing and that they understand the consequences of being accused of Medicaid fraud.
Fraudsters stealing information
Fraudsters sometimes visit nursing homes and offer “medical” services. They do this to obtain Medicare and Medicaid numbers, which they then use to submit fraudulent claims to insurers. Investigators might think you were in on the scam.
Nursing home fraud charges are serious. If you are facing this type of charge, get more information to defend yourself and your business.