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Medicaid Fraud Units Also Target Abuse and Neglect

As many know, nursing homes and long-term care facilities make up part of the wide-ranging community of medical care providers. And as with so many medical care providers like doctors and hospitals, nursing homes typically accept insurance plans as a way to pay for care, and often gladly accept federally-funded programs like Medicare and Medicaid to pay for care of the elderly and those unable to afford care on their own and who do not have private insurance.

These federal dollars add to the tremendous revenue stream that nursing homes enjoy, but as with any government or government-funded program, laws prescribe that such money can be accepted contingent with a promise to operate under specific prescribed rules and regulations. These include making sure that the home provides a certain quality of care, that the facility follows specific protocols with regard to both care and emergency situations, and that the facility remains clean and livable. The Centers for Medicare and Medicaid will perform reviews of facilities or refer investigations to appropriate state agencies. The agency also makes sure that federal money is spent appropriately, and not spent fraudulently on unnecessary treatment or equipment, or on fake expenditures so they can bill the government.

The Purpose of the Investigation Units

The Medicaid Fraud Control Unit (MFCU) is a crucial division that both “investigate[s] and prosecute[s] Medicaid fraud.” Importantly and in addition to this, the unit also “investigate[s] and prosecute[s] . . . patient abuse and neglect in health care facilities” across 49 states and the District of Columbia. It actually specifically exists and operates as a part of state attorney general offices or other relevant state offices since Medicaid is a administered jointly by the federal and state governments, and state governments take on the important task of investigating and regulating nursing homes. The U.S. Department of Health and Human Services (HHS) oversees and ensures that each MFCU operates appropriately.

While these units are often synonymous with investigations and prosecutions for medical providers defrauding the government, it cannot be overlooked how important the MFCUs are when it comes to actual health care of patients. In a recent case in Tuscaloosa County, Alabama, an ex-nursing home employee was indicted by a grand jury for punching a 93 year old resident of the facility, which has been classified as a Class C felony in the state. The indictment came on the heels of an investigation by the Medicaid Fraud Control Unit within the state’s Office of the Attorney General. The state’s MFCU presented evidence to the AG’s office which successfully convinced a grand jury to indict the suspect for a violation of the Adult Protective Services Act.

The face punch allegedly stemmed from the patient refusing to take medication by spitting it back out, and most would see the facility employee’s alleged reaction as wholly inappropriate given many patients, young or old, in nursing homes or elsewhere, routinely refuse medication. This alleged punch was not only a horrendous violent act, but also would amount to a type of physical restraint, which is a common problem in nursing home facilities. The accused is out on bond as the legal process continues. This case is an example of how the MFCU is not just a unit that goes after financial matters and fraud, but goes after homes that abuse or neglect patients and yet continue to accept payments.

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