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For-Profit Nursing Homes & Overcharging

What is the best long-term care facility for my loved one? That is a question that many adult children, spouses, grandchildren, and other trusted relatives ask themselves when an elder’s health deteriorates necessitating special care. Of course, there are no easy answers to that question. The proximity to visitors, size of the home, availability of private rooms, and other factors all combine to suggest which of available options might be best in each individual situation.

One shortcut that some often use relates to the ownership status of the facility. Specifically, do non-profit homes provide better care than for-profit facilities? Some evidence has suggested this to be true. Somewhat insulated from the extreme pressure to maximize their bottom line, non-profit facilities may be able to direct more funds on actual resident care, minimizing nursing home neglect.

Overcharging & Poor Nursing Home Care
Recently, a report was issued that offered even more condemnation of some for-profit facilities. As reported by Bloomberg News, in November headlines were made when Center for Medicare and Medicaid officials found that there may be as much as $1.5 billion in annual overpayments to nursing homes. We discussed those findings on this blog as a reminder of the extreme lengths taken by some facilities to maximize their profits.

Yet, one aspect of those overbillings received less attention: the type of facility that was most likely to overbill. The data suggests that for-profit facilities were far more likely to engage in imprudent billing than non-profit homes. Specifically, while 12% of samples taken from non-profit showed billing improprieties, 30% of for-profit home samples did. That means that more than double the problems were attributed to for-profit homes.

The researchers who made this connection did not mince words when describing what the findings mean. They noted: “The figures add to the case — advanced by health care researchers and Medicare overseers in at least six government and academic studies in the last three years — that the rise of for-profit providers is fueling waste, fraud and patient harm in the $2.8 trillion U.S health care sector.”

More attention has been placed on these for-profit homes, because they are representing a growing portion of the market. In 2010, for example, 78% of nursing home revenues were to for-profit homes. Only a few years earlier, in 2002, that total was 72%. If for-profits are repeatedly shown to provide worse care and not abide by billing rules, then this shift may be a real problem.

Of course not all for-profit nursing homes provide poor care and not all non-profit are bastions of perfect care. However, the trends of general statistics cannot be ignored. That is especially true for community members making decisions about where their loved one may be best served. If other factors are held constant, a non-profit facility may offer clear advantages and lower the risk (though not eliminate it), that your family member will suffer abuse or neglect while in the facility.

No matter what the financial pressures, there is no excuse for providing substandard care or bilking taxpayers. For legal help holding facilities who violate these rules accountable, please contact the legal professionals at our firm to see how we can help.

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