The Problem of Nursing Care Fraud

In the United States, an estimated 20% of nursing homes suffer from nursing care fraud. However, only a small percentage of this fraud is detected, and even then, it is often detected late, which results in limited recovery and wasteful resources. This article explains some of the most common types of health care fraud, as well as how to spot it and avoid it. We also talk about the consequences it can have on residents. The following sections offer a more detailed look at the problem.

Health care fraud

Nursing care fraud is a major problem for medical practitioners. Fraudulent billing is often committed by registered nurses claiming to administer a specific treatment or service. In some cases, nurses are accused of helping doctors submit false claims for ghost patients. In these cases, the fraudster will knowingly use the patient’s health information to generate erroneous claims. Unfortunately, it is impossible to catch all perpetrators, and a patient’s health may be permanently compromised.

There are several ways to detect and investigate this problem. Fraudulent charges are frequently generated when practitioners bill insurance for services or supplies they did not provide. Medical records are often stolen – much more valuable to crooks than credit card numbers – and are used to ring up thousands of phony charges. Unfortunately, healthcare providers routinely commit fraud. Fraudulent billing and misrepresentations are among the most common ways to defraud the government.

Common types

Healthcare providers can commit nursing care fraud in many ways, and it is especially prevalent in nursing homes. Healthcare providers are often not subject to the same level of scrutiny as hospitals, so they can take advantage of vulnerable patients. Unscrupulous administrators and employees can overcharge residents and perform services they are not qualified to perform. Moreover, the patients often are unable to speak up for themselves, making it particularly easy for scammers to take advantage of them. Fortunately, there are ways to detect and prevent nursing care fraud, and whistleblowers can often be helpful in this regard.

The public perception of health care fraud does not reflect the most prevalent causes. Most people think of fraudulent activities that involve individual patients abusing government assistance. While this is a common misconception, there are also cases where health care suppliers or providers defraud state and federal programs. Such schemes often involve large sums of money and are often long-term and complex. In addition to stealing money from patients, healthcare providers can also misrepresent their patients’ medical conditions to get free medical care.


Criminal and civil penalties for health care fraud exist in many forms. While a criminal conviction can lead to prison time, fines and an order for restitution are much less severe. However, both types of penalties can have serious consequences. A physician or nursing home administrator who is caught defrauding a health care insurance company can face jail time. A health care fraud whistleblower can also be retaliated against by the organization, which can result in a loss of job and monetary penalties for emotional distress.

The Medicaid Fraud Control Unit has identified health care providers who defraud the government by submitting fraudulent claims. The majority of these convictions were related to Personal Care Services (PCS) agencies and attendants. Those who commit health care fraud are often not medical professionals but patients. Regardless of the level of care provided, both parties can face criminal penalties. Here are some of the most common criminal offenses committed by health care providers.

Effects on residents

Nursing care fraud can have severe effects on patients and their families and can lead to wrongful death. When medical records are falsely created, a resident who is contraindicated for certain medications may be administered opioids. Ultimately, these medications will kill a resident. A law firm can help families obtain compensation for their loved one’s wrongful death, including funeral costs, burial or cremation expenses, and pain and suffering before death.

Financial abuse in nursing homes is a huge problem, affecting both residents and the insurance-buying public. False claims for unused drugs and services, inflated prices for services rendered, and overbilling are just a few of the ways healthcare fraud impacts residents. Improper financial management and staffing in nursing homes put residents at risk. Nursing homes with inadequate staffing are especially vulnerable to fraud. In addition, residents could suffer from a lack of medications or unnecessary procedures. Falsified medical records may affect patient eligibility and even identity.