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Illinois Nursing Home to Pay $28 Million in Whistleblower Case

A jury recently ordered a nursing home accused of fraudulent billing, among other illegal practices, to pay more than $28 million in penalties. The case was filed after two former employees of the facility came forward with the information. Nursing home negligence lawyers at Pintas & Mullins remind the public that whistleblower cases such as this are critical in exposing and solving senior abuse and neglect.

During the nine-day trial, it was revealed that the nursing home – Momence Meadows Nursing Center – billed more than 1,700 false claims to Medicare and Medicaid. The facility operates as a for-profit nursing home, as most in the United States do.

It is an unfortunate reality that the national increase of for-profit nursing homes is significantly affecting patient care. Those facilities that focus solely on making profits are much more likely to bill the government for unneeded care or for treatment it never administered. According to a recent Bloomberg article, 70% of American nursing homes are run by companies whose main objective is to make money, and 78% of the annual income for nursing homes in 2010 – $105 billion – was enjoyed by for-profit homes.

This marks a six percent increase in profits since 2002. 30% of the billing claims from for-profit nursing homes were considered improper by federal health care inspectors, compared to only 12% of improper billing by non-profits. This article, along with data from Medicare overseers, supports the argument that the national rise of for-profit facilities is also spurring a rise in wasteful, fraudulent, and harmful health care.

Non-profits simply do not have the incentive or need to fraudulently bill, under-staff, or neglect patients. For-profits are owned largely by investors, and their facilities earn a 20% profit on Medicare patients, compared to non-profits, which earn about 9% on those patients. For-profits also employ about 37% less registered nurses per resident, and received almost 60% more deficiency warnings from inspections than non-profits.

The effects of this troubling trend were evident at Momence Meadows Nursing Center, which is why two of its former employees reported the fraudulent behavior to the federal government, who sued the facility under the False Claims Act.

The two employees accused the home of giving grossly inadequate care to its elderly and disabled residents. This substandard care directly led to the deaths of three patients and severe bedsores in countless others. Bedsores become a problem when nursing home staff is so overworked or understaffed that they cannot adequately care for each resident as they require it. Some nursing home residents are bed-ridden or unable to move around without assistance. If they are not moved or turned every few hours, pressure ulcers start to form, and can become infected if not treated immediately. Bedsores that get infected can lead to sepsis, which can ultimately result in death.

The nurses also alleged that Momence Meadows directed them to falsify records for patients and medications to say that care and treatment was given when it was not. Additionally, they were asked to falsify staffing records to indicate that minimum staffing levels had been met, although they had not been. They were also told to re-edit patient charts to conceal events that led up to patient’s injury, illness, and even death.

The workers brought their claims against the facility in 2004, and after their complaints were revealed, they were retaliated against by the facility with threats, verbal abuse, and preventing other facilities from hiring them. Once the government sued the facility under the False Claims Act, however, the employees were fully protected under Qui Tam, or Whistleblower, laws. These laws protect whistleblowers from retaliation and also enable them to recover monetary damages from the verdict, usually around 15 to 25% of the penalties.

The jury ordered the nursing home to pay $19 million in penalties for the fraudulent bills, $9 million for providing unnecessary and valueless services, and$400,000 to the two whistleblowers. In addition to the $400,000 the jury ordered the nursing home to pay the two former nurses, they will also receive a percentage of the penalties. In total, the former employees will receive more than $7 million.

Senior abuse and neglect lawyers at Pintas & Mullins hope this significant verdict encourages similar whistleblowers to come forward with their claims. More information on whistleblowers and qui tam laws can be found here.