Liability under the False Claims Act for inadequate care of nursing facility residents.
The False Claims Act (FCA) was invoked recently to sue the owners of a long-term-care facility for inadequate care of facility residents. The theory is simple: Medicare and Medicaid provider certification agreements require compliance with all federal and state laws applicable to the services provided. Submitting claims for reimbursement while providing inadequate care and, thus, failing to comply with the extensive nursing home quality-of-care federal and state laws, constitutes fraud on the government, actionable under the FCA. No court considered the government's theory in this case, as parties settled early in the litigation. Nevertheless, owners of facilities should not expect to rely on written patient records and case notes to avoid liability for false claims if the records are inconsistent with the physical condition of the residents.
Kurlander
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Latham & Watkins, Washington, D.C., USA.
Scherb
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D005607:Fraud / Q000331:legislation & jurisprudence*; D006801:Humans; D016365:Liability, Legal; D008484:Medicaid / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D009735:Nursing Homes / Q000331:legislation & jurisprudence*; D003668:Pressure Ulcer / Q000451:nursing*; D011787:Quality of Health Care / Q000331:legislation & jurisprudence*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States