Articles Tagged with Medicare/Medicaid

medicaid nursing home patients

Hole torn in a dollar bill with medicaid text

Nursing Home Residents on Medicaid Suffer Most 

Most whose financial situation would be characterized as low income and need to remain in a nursing home for longer than expected, Medicaid will quickly become the primary payer for their long-term care. Designed as a public assistance program for individuals with limited financial support, Medicaid funds a person’s physician visits, hospital, and long-term care, drugs, medical equipment and transportation, and other medical services.

medicare theft

Four Chicago Nursing Facilities Caught Up in Medicare Fraud Whistleblower Case

Some Chicago nursing homes and rehabilitation centers are paying nearly $10 million back to the U.S. government after being caught lying about the level of care their patients required and for violating the False Claims Act by overbilling federal health insurers. Greed came through by abusing power over resident benefits paid for through Medicare and maximizing those amounts under fraudulent therapies and support.

At the center of the fraud sat Quality Therapy and Consultation Inc. of Orland Park, and its owner, Frances Parise. Parise allegedly worked with these four Chicago facilities.

retirement home

Nursing Homes With “No Harm” Deficiencies Are Not Being Held Accountable

Nationwide, a majority of nursing homes voluntarily participate in the Medicare and Medicaid programs. Because of this partnership, facilities must adhere to minimum standards of care established by the federal Nursing Home Reform Law. Those who do not comply, should receive health violations leading to various penalties including fines or in some of the most severe cases, a group’s Medicare or Medicaid certification will be suspended or revoked by the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS).

CMS data indicates that about 95 percent of these health violations are cited as causing “no harm” to residents. In a May 2019 newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition (LTCCC) several examples of these “no harm” deficiencies, taken from Statements of Deficiencies (SoDs) on Nursing Home Compare, were discussed. Surveyors classified all of the shortcomings listed below as “no harm,” meaning that they determined that residents were neither hurt nor put into immediate jeopardy for their health or well-being.

nursing home abuse

AARP Speaks Out on Alarming Proposed Changes to Nursing Home Regulation

At Levin & Perconti we continuously monitor changes to current federal and state nursing home regulations in order to inform our clients of how those changes might impact quality of care. Recently we were pleased to see one of the most powerful lobbying groups in the country, AARP, voice concerns about regulatory actions of the Centers for Medicare & Medicaid Services (CMS) in a letter to the United States Senate Committee on Finance.

Not Enforcing the Rules

healthcare fraud

Miami-Dade Nursing Home Owner Convicted in Largest U.S. Healthcare Fraud Scheme

Just last week, a 12-person jury deliberated for four days before finding Philip Esformes, a 50-year-old entrepreneur and owner of a network of 16 nursing homes and assisted living facilities in Florida, guilty on 20 out of 26 charges related to healthcare fraud. This is believed to be the largest fraud scheme ever charged by the U.S. Justice Department and a reflection of the business owner’s greed through receiving kickbacks, money laundering and conspiracy to commit federal program bribery totaling $37 million. In an April 5th, 2019 public statement, prosecutors called him a “despicable,” “vampire” who was fueled by “unbounded greed.”

“Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes. We will continue the fight against such parasites.”

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