Practice Areas

Nursing Home Fraud

Nursing home fraud involves false Medicare and Medicaid reimbursement claims submitted by skilled nursing facilities, including billing for care that was never rendered, billing at a higher level of care than was provided, or billing for rehabilitation services that were not medically necessary. If you work in a skilled nursing facility or long-term care organization and have witnessed any of these practices, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.

Practice Areas

Nursing Home Fraud

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WHAT IS NURSING HOME FRAUD?

Skilled nursing facilities (SNFs) provide short-term inpatient care and rehabilitation services for patients who require skilled nursing or therapy services following a hospitalization. Medicare reimburses SNFs based on the level of care and therapy services provided to each patient. Medicaid also covers long-term nursing home care for eligible patients.

Nursing home fraud occurs when facilities submit false claims to Medicare or Medicaid for care that was not provided, for a higher level of care than the patient actually received, or for rehabilitation services that were not medically necessary or were performed by unqualified staff. Because these claims are submitted to federal healthcare programs, they fall within the scope of the False Claims Act. Nursing staff, billing employees, therapists, and administrators who have direct, first-hand knowledge of these practices may be eligible to file a qui tam lawsuit on behalf of the government and receive a share of any financial recovery.

American Health Foundation and three affiliated nursing homes agreed to pay $3.61 million in July 2025 to resolve False Claims Act liability for billing Medicare and Medicaid for grossly substandard skilled nursing services provided to residents between 2016 and 2018.

Source: U.S. Department of Justice, July 9, 2025 | justice.gov

Legal basis: 31 U.S.C. § 3729 (False Claims Act) | 42 U.S.C. § 1395i-3 (Medicare SNF requirements) | Source: uscode.house.gov

TYPES OF NURSING HOME FRAUD THIS PRACTICE HANDLES

Nursing home fraud takes several forms. The following are the most common types handled by this practice.

Medicare and Medicaid Reimbursement Fraud: Billing Medicare or Medicaid for skilled nursing services at a level or quantity that does not reflect what was actually provided, including billing for the highest reimbursement category when the patient’s condition does not support that classification, submitting claims for therapy minutes that were not provided, and falsifying clinical documentation to support a higher reimbursement level than the patient’s actual condition warrants.

False Claims for Care Not Rendered: Submitting claims to Medicare or Medicaid for nursing, therapy, or other services that were never provided to the patient. This includes billing for services by staff who were not present or who were not qualified to provide the services billed, documenting care in the patient’s record that did not occur, and submitting claims for care provided at such a grossly substandard level that it had no legitimate medical value, which courts have recognized as equivalent to billing for services not provided.

Legal basis: 31 U.S.C. § 3729(a)(1)(A) and § 3729(a)(1)(B) (False Claims Act) | 42 U.S.C. § 1395i-3 (Medicare SNF requirements) | 42 U.S.C. § 1396r (Medicaid nursing facility requirements) | Source: uscode.house.gov

WHO CAN REPORT NURSING HOME FRAUD?

The strongest nursing home fraud qui tam cases come from current or former employees who have direct, first-hand knowledge of the fraudulent conduct from inside the facility. This includes nurses and nursing aides who know what care was and was not provided to residents, physical, occupational, and speech therapists who are aware of therapy minutes being inflated or documented for sessions that did not occur, billing and MDS (Minimum Data Set) coordinators who process Medicare and Medicaid claims and are aware of discrepancies between the clinical record and what is billed, administrators and compliance officers who have identified fraudulent billing patterns within the facility, and physicians who are aware of documentation being altered or created to support a higher reimbursement level.

You do not need all the documentation before contacting us. If you have witnessed conduct that you believe constitutes false billing to Medicare or Medicaid for nursing home services, that is enough to start a confidential conversation. We investigate thoroughly before asking for any commitment.

In fact, many former employees come forward with knowledge of fraudulent practices by their former employers after they have been demoted or terminated for complaining to their supervisors about the fraudulent practices or leaving their employment because they refuse to participate in the fraud.

Legal basis: 31 U.S.C. § 3730(b) (qui tam provisions) | Source: uscode.house.gov

YOUR PROTECTIONS AS A WHISTLEBLOWER

When you file a qui tam complaint, it is submitted under seal and served on the Department of Justice and any state agencies that have been impacted by the alleged fraud. During the time the case is under seal, your employer is not notified and does not receive a copy of the complaint. Your identity remains protected throughout the government’s investigation.

The False Claims Act prohibits your employer from firing, demoting, suspending, harassing, or otherwise retaliating against you for reporting fraud or participating in a qui tam case. These anti-retaliation protections apply to both current and former employees.

If your employer retaliates against you, you have legal remedies that include reinstatement, two times the amount of back pay owed, interest on that back pay, and compensation for special damages including litigation costs and attorney fees.

Legal basis: 31 U.S.C. § 3730(h) (anti-retaliation) | 31 U.S.C. § 3730(b) (under seal filing) | Source: uscode.house.gov

WHISTLEBLOWER REWARDS

When a qui tam lawsuit results in a financial recovery, the False Claims Act entitles the relator to receive a percentage of the total amount recovered by the government. If the government intervenes and takes over the case, the relator may receive between 15% and 25% of the recovery. If the government declines to intervene and the relator proceeds independently, the share can rise to between 25% and 30%. There is no cap on the dollar amount of the reward. We work on a contingency fee basis. There is no upfront cost, and if there is no recovery, you owe us nothing.

Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2) | Source: uscode.house.gov

About This Practice

Arvind Bob Khurana has over 27 years of experience in qui tam and False Claims Act litigation, complex commercial litigation, and class action matters. He began his career at a top international defense firm and joined a national class action firm in 2005, becoming partner in 2009, where he worked on ERISA actions, qui tam cases, securities fraud, and antitrust matters. He is admitted to the New York State Bar and represents whistleblowers in federal courts nationwide.

We are selective. Before we ask for any commitment, we investigate the claim, explain the facts and the risks, and give you a complete picture of what you are facing. We never ask you to sign a retainer agreement until you have the full picture and have decided, on your own terms, that you want to move forward. You remain in control throughout.

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Arvind Bob Khurana has over 27 years of experience in complex litigation. We work on contingency. There is no upfront cost and no obligation to proceed.