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Aug 15, 2022 by |

Nursing Home Financial Fraud

Each year, thousands of families come to the realization that they can no longer provide the level of care that their elderly loved ones require and make the difficult decision to place their care in the hands of professionals. Placing an elderly family member in a nursing home is often the right thing to do; most nursing homes provide high-quality care to their patients and are staffed with individuals who want to help. However, many nursing homes are for-profit enterprises whose overarching concern is their bottom line. Nursing homes that prioritize profit over care may be tempted to engage in nursing home financial fraud. If you suspect that you or someone you care about is the victim of fraud, you should consider speaking to a California financial fraud attorney.

Nursing Home Financial Fraud Is Elder Abuse

Financial elder abuse is a broad category of behaviors that enrich the perpetrator at the victim’s expense. As the most common form of elder abuse, it can involve:

It generally occurs when a nursing home takes advantage of its patients for financial gain in one way or another. This type of financial elder abuse can be difficult to detect, as it is often perpetrated through opaque nursing home bureaucracies, giving its perpetrators at least some measure of plausible deniability. It also has the potential to affect a large number of people. Rather than a single actor preying upon an individual nursing home resident (although residents are at risk of that too), nursing home financial fraud tends to occur at the administrative level, which puts all residents of the facility at risk.

Types of Nursing Home Financial Fraud

There are several ways that nursing homes can perpetrate nursing home financial fraud, as shown below. 

Overcharging for Services

Nursing care is expensive, and billing rates depend upon a number of factors, such as location, the complexity of care, room type, and amenities. However, most patients and their families negotiate the cost of nursing care upfront and expect to pay the same amount each pay period. Even if the patient selects extra à la carte services — such as a once-monthly hair cut — those services should cost the same each payment period. If an add-on service suddenly increases in cost, the nursing home may be overcharging.  

Charging for Services Not Rendered

Nursing homes provide a wide range of services to their residents. This can include physical therapy, group outings, art and music classes, seminars, and more. In some cases, however, a nursing home may attempt to charge the patient’s account for a service in which the patient did not participate.

Failing to Provide Paid-For Services

Some nursing home residents demand a higher level of care than others and receive more services than the average resident. In theory, this is financially advantageous for the nursing home. But nursing homes and their staff may be tempted to maximize their profits even further by cutting corners and failing to provide the paid-for services

Charging for Complimentary Services

Nursing homes typically offer their residents a menu of complimentary services, such as transportation to church or doctor’s appointments. Before placing a loved one in a nursing home, be sure to read the fine print so that you understand exactly which services you are expected to pay for and which are complimentary. It can be tempting for unscrupulous nursing homes to add a charge for a complimentary service and hope no one will notice.  

Misappropriation of Resident Finances

While nursing homes typically do not have access to their residents’ finances, they may sometimes be the trustees of a patient’s resident trust fund. These are accounts that nursing homes hold in trust on behalf of the patient and can be used to pay any expenses they incur. As the trustee, any breach of fiduciary duty — such as embezzlement of funds from the account — can be considered nursing home financial fraud.

Indicators of Nursing Home Financial Fraud

It is difficult to prove nursing home financial fraud. It is often perpetrated through the nursing home’s administration, making thus making it hard to point the finger at any one specific person. Actions that seem like nursing home financial fraud could also be the result of honest mistakes. There are several red flags that nursing home financial fraud may be occurring, such as:

  • Unusual, unexplained, or inflated charges on a billing statement
  • Charges for services that you know were not rendered
  • Charges for services that were rendered without prior approval from the resident
  • Complaints by the resident that paid-for services are not being provided
  • Diverted Social Security checks
  • Unusual activity on the resident’s trust fund

If you have noticed any of these phenomena, please consider speaking to a California nursing home financial fraud attorney who can evaluate your claims and help you decide on the best course of action.

California Nursing Home Residents Have a Right to Be Free from Nursing Home Financial Fraud

Nursing home residents in California enjoy a variety of rights granted by both state and federal law. For example, all nursing home residents in California have the following rights:

  • The right to know what care and services are included in the daily rate
  • The right to know what services are available and what the charges for them are
  • The right not to be charged for services you did not request
  • The right to 30 days’ notice prior to raising rates for any service
  • The right to be informed of any charges made to you
  • The right to a quarterly statement concerning money handled by the nursing home

Contact a California Nursing Home Financial Fraud Attorney for More Information

Nursing home financial fraud often goes undetected and unaddressed. If you suspect that you or someone you care about may be its victim, please contact California nursing home financial fraud attorney Ingrid M. Evans at Evans Law Firm, Inc., by using our online form or calling us at 415-441-8669 or toll-free at 1-888-50EVANS (888-503-8267).

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