The False Claims Act as a remedy to the inadequate provision of nutrition and wound care to nursing home residents.
Under the federal Nursing Home Reform Act (NHRA), long-term care (LTC) facilities must provide care adequate to maintain residents' highest practicable physical, mental, and psychosocial well-being. Long-term care facilities that participate in Medicare and Medicaid also must meet specific requirements set by the federal and state governments and, by submitting a claim for reimbursement, certify that the services billed were actually provided. This case report centers on a Pennsylvania LTC facility that was sued by the federal government for inadequate care of three residents. For the first time, the government used the NHRA and the federal False Claims Act to enforce quality of care standards set by Congress. The implications of this case-that providing inadequate care now translates into a false claim to the government for payment-are dramatic for LTC facilities that care for Medicare and Medicaid patients.
Hoffman
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D000368:Aged; D005260:Female; D005607:Fraud; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards*; D010414:Pennsylvania; D003668:Pressure Ulcer / Q000209:etiology*; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D014481:United States