medicare

$38 Million Settlement for Nursing Home’s Medicare Fraud

Washington will receive about $1 million in reimbursement for Medicaid and Medicare charges billed by Extendicare.

The nursing facility company is paying out $38 million to eight states and the federal government. A Department of Justice investigation found that Extendicare billed for care that didn’t meet Medicare standards—or in some cases, didn’t happen at all—including:

–       Procedures to prevent pressure ulcers, and prevent falls

–       Improper staffing, providing too few skilled nurses

–       Failure to provide proper catheter care

When a nursing home bills Medicare for patient services, the facility has to meet basic standards of care.

Extendicare currently operates 146 nursing facilities in 11 states (15 are in Washington). Of those, 33 nursing homes billed for patient care that did not meet federal and state standards.

The Extendicare investigation, prompted by two whistleblowers in separate nursing facilities, found that Extendicare billed Medicare and Medicaid for services that “were so deficient that they were effectively worthless…”

Extendicare also billed for unnecessary rehabilitation services, timed with the goal of charging Medicare as much as possible.

“Health care providers must make decisions regarding the level of services to be provided based solely on their patients’ clinical needs, and not corporate financial targets.”

– Acting Assistant U.S. Attorney General Joyce R. Branda

According to the Seattle PI’s Boomer Consumer investigator, $595,000 of Washington’s reimbursement will go to the federal government for its share of Washington’s Medicaid program.

Medicare fraud is a serious crime: reporting is crucial for holding nursing homes and other medical facilities accountable.

How do I know if a nursing home is safe?

There is no way to be 100% certain that your elderly relative won’t suffer an injury or trauma in a nursing home.

But when it comes to elder care, knowledge is power. If a home has history of abuse or neglect complaints, it’s a sign of serious, systemic problems.

Search for nursing home complaints 

Medicare tracks nursing home violations and deficiencies. Nursing Home Inspect has organized that data: you can search for a specific facility – for example, “Harborview Hospice”; or by location – “Aberdeen, Washington”. The information is updated monthly, and covers the past three years.     

  • How many complaints – or “deficiencies” have residents filed?

For example, Kittitas Valley Health & Rehab Center in Ellensburg, Washington has a shocking 59 verified complaints.

  • How severe are the violations?

Severity ratings range from “A” violations—the least severe, usually the potential for harm, without actual damage— to “L” violations, the most severe incidents, occurring in a pattern.

  • What actually happened?

Medicare’s incident reports are included; you can see the details of specific incidents, and know what to watch for if you have a relative in that facility.

Coluccio_Law_Nursing_Home_Checker

A search for “Seattle, Washington” found 216 elder care facilities, with a total of 913 deficiencies.

 

This is a great resource, but one of the best things you can do to ensure a safe, healthy nursing home experience is to go there often, and on various dates and times.

If the residents generally seem happy and healthy, it’s a good sign.

If you suspect something is wrong, you’re probably right. Request an investigation.

See: How to file a Nursing Home Complaint: 4 easy steps. 

 

About Kevin

Kevin Coluccio was recently named one of the Top 10 Super Lawyers in Washington State. He has long history of successful elder abuse/neglect cases and has a stellar reputation for getting results for his injury clients in serious car crashes, pedestrian accidents, trucking accidents, maritime claims, and asbestos injury cases.