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Billing fraud case helps highlight nursing home risks

On Behalf of | May 30, 2023 | Long-term Care Facility Neglect |

When stories of substandard nursing home care make the news, the reason often has to do with someone getting hurt or family members taking legal action against a facility when someone dies. However, there are other news stories related to life in nursing homes that can shed light on the risk that residents face on a daily basis as well.

For example, recently, a large settlement related to billing fraud involving an East Bay nursing home has helped draw attention to the lackluster standard of care at that facility and possibly many others.

What led to the settlement?

The San Miguel Villa, a for-profit nursing home in Concord owned by Tranquility Incorporated agreed to a settlement that will see the company pay $2.3 million. The settlement is the result of negotiations following claims against the organization for fraudulent billing. The facility allegedly billed both Medicare and Medi-Cal for nursing home services that did not meet minimum requirements. There were numerous cases of what prosecutors called “grossly substandard” care between 2012 and 2017 that led to the claims against the facility.

Allegations included over-medicating patients, neglect that led to resident falls and exposure to violence both from staff members and other residents. The settlement will cut into the profit margins for Tranquility Incorporated and may push the company to enforce a higher standard of care in the future. This case is a stark reminder for those with loved ones in nursing homes that profit incentive can lead to very poor care standards.

Cost-cutting affects the quality of life for residents

Attempts by companies running nursing home facilities to minimize their operational expenses often mean reducing how many workers there are at the facility and therefore how much support individual residents receive. Chronic understaffing at a nursing home often translates into poor quality of living and unnecessary injury and illness for the people living there.

Family members may be able to file legal claims against facilities that do not adhere to state standards regarding the care that they provide, not unlike what the state did in this case. Holding a facility accountable in the civil court system may be one of the only ways for family members to fight back against nursing home neglect that affects their loved ones.

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