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Hospital Executives Charged in Medicare Scam for Steering Elderly Residents to Mental Health Clinics

The Houston Chronicle reported this week on a new criminal case being launched against hospital executives for running an apparently $116 Medicare scam. Our Illinois nursing home abuse attorneys know that the situation is yet another reminder that when it comes to elder neglect money truly is the root of all evil. According to allegations being made in the criminal case, a senior general hospital executive was apparently involved in a kickback scheme that bilked taxpayers out of well over a hundred million dollars in funds. The fraudulent actions sent money to patient recruiters and nursing home owners in exchange to sending those patients to mental health clinics run by the general hospital.

The charged executive managed the day-to-day operations of the hospital’s clinics. The bizarre accusations suggest that the executive also bribed “patients with cigarettes, food, and coupons redeemable at the hospital’s ‘country stores’ in order to entice them to therapy.” Of course the facility stood to gain financially from having these seniors and disabled community members use their particular services, regardless of whether they needed those services or not.

The specific charges against the man claim that, along with co-conspirators, he submitted$116 million in claims to Medicare for mental health services that were not need or not even provided. The patients were steered to the facility by paying off those who made decisions about where to send patients. In one case a recruiter was paid $5,000yearly. In another case a recruiter was apparently given $300 for every patient that he directed toward one of the clinics managed by the hospital administrator. Other allegations implicate a nursing home. Apparently, the executive paid the owner of the facility nearly $4,000 in exchange for the owner referring residents to the hospital in question.

Our Illinois nursing home lawyers appreciate that these situations occur in various degrees across the country. When these institutions are privatized, with immense pressure to maximize profits, then the priorities become skewed. At the end of the day the well-being of the patient (or long-term care resident) must always remain of pinnacle concern. Yet, money often displaces well-being in that assessment. When that occurs, elder neglect and abuse is much more likely to occur. Short staffing and under-training are the most common ways that these misguided prioritized materialize. When owners care most about maximizing profit, they are willing to risk lives with inadequate caregivers. Those even more desperate to make money will engage in conduct like that alleged here, with kickbacks, fake treatment, and unnecessary services paid for by the public.

These situations cannot be tolerated. The only way to make sure things change is to hold those who engage in these practices fully accountable. Private citizens have a role to play. When you suspect a nursing home near you is not committing the resources necessary to keep patients safe please do not remain silent. Report the situation to state officials, visit with elder advocacy group, and contact legal professionals to understand what can be done to demand changes and ultimately save lives.

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