As the baby boomer generation ages, the already growing and profitable nursing home industry is primed for a boom. With 63% of residents on Medicaid and another 14% on Medicare, the temptation for unscrupulous nursing homes to puff up government reimbursement claims with fraudulent information is growing rapidly as well. Fraudulent claims include billing for unnecessary rehabilitation services, billing for expensive supplies and equipment that was not used or necessary, improperly classifying patients in order to inflate reimbursements, and ordering unnecessary medical tests.
Some fraud involves kickback arrangements for patient referrals and sweetheart arrangements with hospitals or pharmacies. The details and schemes may vary but this type of fraud is illegal and in violation of the False Claims Act. Both the facilities and their corporate owners who are lining their pockets with government money can be liable for this type of fraud.
Fraud of this nature doesn’t just affect the current residents, who aren’t benefiting from the money which is meant to provide care for them. It can also affect future generations, who may see a Medicare and Medicaid system which cannot support both the ballooning costs of the baby boomers as well as unchecked greed and fraudulence from for-profit facilities. See article at Justice News Flash.