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Nursing Home Faces Medicare Fraud Charges

Underlying most instances of nursing home neglect is the drive for profit. Common themes in many neglect lawsuits are cut corners, poor staffing levels, inadequate training and other deficiencies which could be remedied if long-term care facilities committed sufficient resources to keeping residents safe and secure. Sadly, instead of dedicating enough resources to senior well-being, many facilities slowly chip away at budgets. This may increase profits to owner and shareholder, but it can be downright deadly for senior residents.

Financial incentives are also seen in nursing homes in other ways. Not only do some homes try to cut resources from actual caregiving services, but at times they try to collect more resource than they are owed by taxpayers. This takes the form of Medicare and Medicaid fraud, and it is critical that it be rooted out at all times. Public resources are limited, and we must ensure that they are used in the most efficient way possible.

New Federal Fraud Lawsuit
Fortunately, there are legal avenues to hold corporate fraudsters accountable when they take more than they are due from federal coffers, usually in the form of illegal Medicare and Medicaid receipts.

For example, the Sun Chronicle reported recently on a new federal lawsuit naming a nursing home chain as defendant. The underlying issue in the suit stem from billing problems. The officials claim that the chain billed Medicare for services that were not medically necessary, not of a skilled nature, and not covered under the Medicare rules.

The suit follows an extensive 2010 federal report that was critical of the way that long-term care facilities bill Medicare and Medicaid. Various problems were identified industry-wide, and enforcement officials have been slowly getting more and more aggressive in tracking down those who violate the rules to pad their own profits.

As usual, the defendant-nursing home chain rejected the charges, claiming that all of their programs are useful and a good use of public resources.

Medicare Payments
When an individual on Medicare enters a long-term care facility for covered services (usually temporary nursing home stays), then the facility is paid a set daily rate by the program depending on the individual resident needs. Certain resident needs–including those requiring “ultra high” levels of rehabilitation–are reimbursed by Medicare at higher rates. Perhaps expectedly, some facilities tend to claim a large number of payments for these “ultra high” services–even when the resident does not need those services.

In fact, according to this latest lawsuit, the nursing home chain set “targets” for individual facilities to meet regarding these ultra-high services. Punishments were allegedly handed down when those targets were not met. Instead of making decisions based on the unique needs of those residents using their services, care decisions were based on profit for the company itself. It is like a grocery store forcing customers to to buy products based on what had the largest mark-up, instead of what they actually needed.

This sort of conduct is entirely unacceptable and cannot stand. Not only does it bilk taxpayers out of funds, but it harms residents and limits the resources that can actually go to proper, necessary, and worthwhile care.

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