We tend to respect and have faith in our Kentucky doctors and other medical professionals. In general, they earn this esteem; sometimes, however, our respect and faith are misplaced.

Particularly incorrigible are fraud and abuse perpetrated on the elderly in Kentucky nursing homes. Unethical doctors, nurses, hospital personnel, and other healthcare providers have been known to act in some of the following unethical ways:

  • charging for services they do not provide;
  • overcharging or double-billing for medical care or services;
  • collecting kickbacks for referring patients to certain providers or for prescribing certain drugs;
  • over- or undermedicating;
  • recommending fraudulent remedies for medical conditions; and
  • committing Medicaid fraud.

Healthcare Fraud vs. Abuse

The National Institute of Health clarifies the difference between healthcare fraud and abuse. Health Insurance Portability and Accountability Act, or HIPAA, defines healthcare fraud as when a party “knowingly, and willfully executes or attempts to execute a scheme…to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by…any healthcare benefit program.” Healthcare abuse is similar to fraud except that no evidence can be found that the party committed the act knowingly, willfully, and intentionally; the intent to commit is necessary to prove fraud.

Preventing Healthcare Fraud and Abuse

Healthcare fraud and abuse costs not only individuals but insurance companies, as well. When insurance companies lose money, they make up their losses by increasing their rates. It may then become unfeasible for many people to afford the health insurance they need.

Blue Cross and Blue Shield (BCBS) have the following recommendations to keep you or your loved ones—whether in a nursing home or not—from becoming victims of healthcare fraud and abuse:

  • Check your insurance Explanation of Benefits to make sure that the dates of service, provider names, and types of services reported are accurate.
  • Keep your insurance card and documents containing personal information safe and inaccessible to others.
  • Count your pills when you pick up a prescription.
  • Check information on your healthcare providers through the state medical board.
  • If you believe that you have been a victim of fraud or abuse, report it to your insurance company immediately.

Has Your Loved One Been Injured In A Nursing Home?

If you believe your loved one is being subjected to nursing home abuse you need to speak with an experienced Kentucky nursing home neglect attorney as soon as possible. Contact us online or call our office directly at 888.450.4456 to schedule a free consultation.

Mark K. Gray
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Louisville attorney serving the seriously injured in Kentucky