A provision in the FCA, called Qui Tam, allows persons with evidence of fraud in federal programs or contracts to bring a lawsuit on behalf of the federal government. A notice should be posted in every nursing home broadcasting the fact that under the provision, whistleblowers are entitled to 15 30% of monies recovered in the lawsuit and maybe if enough lawsuits were filed, the industry would start cleaning up its act..
The roughly 16,400 nursing homes in the US house approximately 1.7 million residents. But despite years of evaluations, investigations, and more recently lawsuits, in 2006, the state of America's nursing home system, entrusted to provide care to the country's most vulnerable citizens, is every bit as shameful as it was 10 years ago.
Of the 16,437 certified nursing homes nationwide, just 314, or fewer than 2%, were found to be violation free during a fou- year period, according to an analysis of federal inspection and complaint investigation reports by Gannett News Service.
Where a nursing home is located and who owns it was found to be critical when evaluating the care provided to its residents. Nearly 75% of severe and repeated violations of patient care between 1999 and 2003 were found at nursing homes in 12 states, including Texas, Illinois, Arkansas, Washington, New Jersey, Kansas, Missouri, Indiana, Oklahoma, North Carolina, Mississippi and Tennessee.
During its investigation, GNS interviewed dozens of people and analyzed 4 years of federal data on inspections and patient care and found that for-profit nursing homes accounted for 83% of the more than 500 nursing homes with repeated, serious violations, even though the for-profits accounted for only 65% of all Medicare and Medicaid certified nursing homes.
"Patients at for-profit homes had, on average," GNS said, "higher rates of infections and pressure sores than those the government and nonprofits own. Other violations found included failing to protect patients from mistreatment, hiring staff without running criminal background checks, and allowing patients to be abused and physically punished."
In the real world, running criminal background checks on staff or residents is a waste of time to nursing homes that fail to protect residents against known criminals.
A case on point, is Barbara "Bee " Becker, who has been a tireless advocate for nursing home residents since 1999 when her mother-in-law, Helen Straukamp, became a victim of a homicide at a nursing home in Evansville, Indiana when she was assaulted by a male resident.
Not satisfied with an inadequate investigation conducted by the facility, Bee began her own investigation of her mother-in-law's death and discovered that the perpetrator of the crime had a violent criminal record and the nursing home knew it.
The facility told the attending hospital, that Mrs Straukamp had been injured when she had suffered a fall. However, an employee later told the family that she had been assaulted, and an eyewitness described how Mrs Straukamp was picked up by her arms from a standing position, lifted off the floor and slammed into a wall and handrail, and fell to the floor unconscious.
Mrs Straukamp died 22 days later. The coroner ruled her death a homicide but the crime was never prosecuted.
On March 4, 2002, after listening to Bee describe how her mother-in-law had been a victim of a crime but there was no prosecution because it took place in a nursing home, at a hearing before the Senate Select Committee on Aging, Committee chairman, Senator John Breaux, announced that "a crime is a crime wherever it is committed. "
Bee says she looks forward to the day when all crimes against elderly citizens in nursing homes will be prosecuted in the same manner as they are when they occur elsewhere.
According to Indianapolis Attorney, Kennard Bennett, "there are some straightforward reasons why crimes in nursing homes are often not prosecuted."
First, he says, the victim is most likely unable to be their own witness as to what happened because of their dementia. "Nursing home residents are extremely vulnerable to predators for this very reason," he explained. "There may be no other witnesses to the crime."
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One of the most effective weapons the government has for unearthing fraud against Medicare and Medicaid in the nursing home industry is the False Claims Act. The fraud is so rampant in that industry that it should be officially designated as a breeding ground for whistleblowers.
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