Power to the people? That could mean trouble

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor

There are plenty of legal concerns that keep nursing home administrators awake at night. Many times, the demons can be kept under the bed or locked in the closet. But not always.

In a drama that could be subtitled, “When bad things happen to good people,” a group of long-term care attorneys met recently to discuss some of their most vexing problems. The occasion was the American Health Lawyers Association's long-term care confab in Austin, TX, at the end of February.

The good news is, they were immersed in the big topics — from managing government subpoena responses in the “e-discovery world,” to ZPIC and RAC audits (“what you need to know”), and much more.

The bad news is they had to sit down and parse the latest, most worrisome developments on these hot topics. The long-term caregiver is truly under siege today. 

One can only hope that the bad ones become unnerved and decide to fold their tents, go home and try to make careers at online poker.

That's because federal authorities are not going to make it any more comfortable than they have to for providers they think are doing wrong. And they have more brave allies than ever before to help wage this growing battle: your long-term care employees.

That's what came to mind when the news broke out of Tennessee last month about a regional provider reaching a $2.7 million settlement in a therapy billing case. Grace Healthcare, which maintains its innocence, felt the bite of federal authorities only because one of the provider's own (former) employees had become upset with workplace practices and pursued legal action.

Keep in mind that these whistleblower (or qui tam) cases originate with an individual person filing a complaint. The federal government doesn't always jump on the bandwagon but they seem to have been doing so more and more often. Make no mistake: When Uncle Sam joins the fray, what might have been just a headache becomes a major threat for the accused.

High-profile provider prosecutions for False Claims Act complaints once were just headlines, coming out of a portion of Pennsylvania. As Tennessee's recent spate of ugly stories shows, the movement has clearly taken foot, and it's spreading.

Provider, ignore at your own risk.

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