Improper, inflated or unlawful medical billing practices are forms of health care fraud that could affect the quality of life of anyone receiving nursing home care in New Mexico. It's nursing home residents with their care funded partially or completely by Medicare, Medicaid or private insurance who are especially susceptible to this type of health care fraud.
Billing for services not performed, double-billing, billing more than the actual cost for services and billing for services or items not covered by insurance are examples of what may be considered health care fraud at nursing homes. Some offenders also offer kickbacks in exchange for residents' medical records or access to unused drugs. Under-staffing is considered a possible sign of both health care fraud and nursing home abuse if residents aren't even receiving basic care.
This type of fraud ultimately affects residents in many ways that could be harmful. For instance, elderly nursing home patients with physical or mental limitations may be placed at risk if they are forced to undergo unnecessary procedures or take medications they don't need to justify fraudulent billing. If nursing home staff are selling unused drugs, residents may suffer because of medication shortages. Also, falsified medical records created without a patient's knowledge could affect their eligibility for future care they may need as can identify theft resulting from stolen medical records.
Nursing home staff and service providers are usually in the best position to spot signs of health care fraud. It's just as important for family members to keep an eye out for signs of anything unusual. If fraudulent activities are suspected, a nursing home abuse lawyer may bring in an impartial accountant or auditor to review a resident's medical records and the nursing home's billing documents to find evidence of fraud or deceptive practices.