Federal Healthcare Inspectors Reveal Nursing Home Fraud, Negligence

Over the years, federal healthcare inspectors with the U.S. Department of Health and Human Services Office of Inspector General have found many problems with nursing homes, one being improper billing. According to recent data, their findings are seemingly accurate.

Results of the study

A report was recently issued this past November by the U.S. Department of Health and Human Services which shows that many nursing homes have allegedly defrauded the government for over a billion dollars.

The information in the report was based on a study conducted by the Office of Inspector General. Random samples of patient medical records from 2009 were examined from skilled nursing facilities, or SNFs as they’re referred to. Each medical record was then compared to each claim information that was submitted by the SNF.

The data revealed that approximately one-quarter of all of the claims-totaling $1.5 billion-seeking reimbursement from the federal government were fraudulent or in error. Alarmingly, the report showed that many facilities billed for treatment that was never even provided to patients.

Patient care takes back seat with for-profit nursing homes

According to the latest data, profits over patient care isn’t surprising-particularly when it comes to for-profit nursing home facilities.

Figures from 2010 demonstrate that nursing homes earned $150 billion in revenues. And 78 percent of that $150 billion was earned by for-profit nursing facilities-up from 72 percent in 2002.

According to a study published in 2012 by the Journal of Health Services Research & Policy, the “10 largest for-profit nursing-home chains employed 37 percent fewer registered nurses per patient-day between 2003 and 2008-and received 59 percent more deficiency notices from government inspectors-than non-profits did.”

Gary Cantrell, Deputy Inspector General of the U.S. Department of Health and Human Services, says that civil and criminal cases against skilled nursing facilities for nursing home abuse have also risen over the years. Cantrell says federal prosecutors brought 120 civil and criminal cases against skilled nursing facilities during a 4 year period from 2008-2012-a 60 percent rise from years before.

Specifically, a popular for-profit nursing home chain with 75 locations has been a target of investigation in recent months. The SNF giant is facing 11 criminal counts of elder abuse.

Another SNF conglomerate is also facing civil allegations after one of their locations allegedly forced an 80 year old patient to undergo unnecessary and life threatening treatment in which the complaint alleges she later died from.

New oversight

In the wake of the report and, in an effort to maintain clearer oversight and accountability with SNFs, the Centers for Medicare and Medicaid Services made changes to their payment systems.

However, this likely brings little reassurance to individuals with loved ones residing in nursing home facilities today. Just like any for-profit company, even when people’s lives are at stake, profits-and shareholders-always seem to come before care.

Now is more important than ever for individuals to consult with a nursing home abuse attorney if they suspect that their loved ones are suffering abuse or neglect. A lawyer knowledgeable in the law and the rights of elderly patients can evaluate the facts and pursue aggressive legal resource if needed.

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