Nursing homes are no longer under the radar

Nursing homes are becoming increasingly vulnerable to penalties and lawsuits. Headlines previously more common in the hospital environment now target long term care on a regular basis:

• February 2013. A federal jury imposed a $28.1 Million penalty against the former owner of Momence Meadows Nursing Center in Kankakee, IL. The home was charged with submitting false or fraudulent claims to Medicare and Medicaid for substandard care.

•  February 2013. Fairfax Nursing Center (Fairfax, VA) agreed to a $700,000 settlement with the government to resolve False Claims Act allegations. The Justice Department alleged that Fairfax knowingly submitted claims to Medicare for non-reimbursable rehabilitation therapy that was excessive, duplicative, medically unnecessary, or lacking in clear goals or direction.

• January 2013. The former DON of Kern Valley Health District in California was sentenced to 3 years in prison on a felony charge of elder abuse. The DON ordered the administration of psychotropic drugs for 23 skilled nursing patients. She ordered the drugs to control the patients, rather than for medical reasons. The administrator was sentenced to 3 years' probation, 300 hours of community service, and restitution for failing to supervise the DON.

• November 2012. The Justice Department brought False Claims Act charges against Life Care Centers of America. The government alleges that Life Care submitted claims to Medicare and TRICARE for therapy that was not medically reasonable and necessary, and schemed to maximize reimbursement for ultra high therapy.

Now more than ever, effective compliance programs are needed to keep ahead of government enforcement-and out of the headlines.

Margaret Scavotto

                              General Counsel & Compliance Manager