Each year, the Department of Justice (“DOJ”) announces its areas of focus for the upcoming year, giving providers an idea of where to expect enforcement action. In its most recent update, the DOJ announced plans to make improper care and billing at nursing homes and skilled nursing facilities a priority in 2020.
Patient-Driven Payment Model
In recent years, DOJ investigations have focused on the excessive utilization of therapy services for nursing home and skilled nursing facility residents. These facilities have recently started using a new system called the Patient-Driven Payment Model (“PDPM”), which assigns reimbursement amounts based on the degree of clinical complexity of the residents and their need for resources. Proper coding under this new system will likely be the focus of the DOJ’s initial work. Prior False Claims Act cases addressing upcoding for unnecessary services and services not provided at all may be used as precedent against facilities struggling to adjust to PDPM. And although the DOJ plans to increase its focus on nursing homes and skilled nursing facilities to prevent fraud, there is no foolproof system to prevent all wrongdoing by entities receiving federal funds. Fraud against the federal government is rampant, and the government frequently relies on whistleblowers to help it recover funds.
How this Affect Whistleblowers
DOJ’s new initiative may be enforced under the False Claims Act. Under the False Claims Act, a whistleblower with knowledge of fraud against the federal government can file a lawsuit on the government’s behalf. A whistleblower is an individual who possesses original information about the submission of false claims to a federally funded program. When a whistleblower files a lawsuit under the False Claims Act, he or she may be entitled to financial compensation. Specifically, a successful False Claims Act lawsuit can result in an award of up to 30% of the federal government’s total recovery. Given the large amounts of money typically associated with Medicare fraud, this can amount to a substantial reward. In fact, whistleblowers frequently receive millions of dollars for the information they provide.
Contact a False Claims Act Attorney Today
If you have information that may lead to the recovery of funds that were fraudulently obtained from the federal government, you may be entitled to financial compensation under the False Claims Act. However, if you make any mistakes when you report this information, you run the risk of receiving nothing. Therefore, if you have knowledge that a person or entity has committed fraud against the federal government, you should contact a False Claims Act attorney for assistance with your claim. An experienced False Claims Act attorney will ensure that you cover all of your bases when reporting fraudulent activity under the False Claims Act, giving you your best chance at financial recovery. Please contact us today for a consultation.