2018 OIG Medicaid Fraud Report Released

Nursing home committing medicare fraud according to OIG report

The Office of the Inspector General (OIG), along with the Department of Health and Human Services, charged over 600 defendants with crimes regarding over $2 billion dollars in Medicare and Medicaid fraud in the year 2018.  The 2018 OIG Medicaid Fraud Report shows strong government interest in going after fraudsters, including nursing homes and assisted living facilities, who cheat the taxpayer by engaging in fraud.

One of the key sources for the development of these fraud cases is current or former employees who can show that a facility is defrauding Medicare or Medicaid.  In fact, the government, through the False Claims Act, allows a whistleblower to get a significant percentage of any fraud recovery.

If you know of Medicare or Medicaid fraud occurring at a hospital, nursing home or assisted living facility, call the Whistleblower lawyers at Senior Justice Law Firm for a free consultation.

Who Was Held Accountable in the 2018 OIG Medicaid Fraud Report?

Both federal and state agents participated in large-scale investigations to discover fraud in the healthcare system.  This group included over 1,000 law enforcement personnel, of which 350 came from the OIG.  The stated goal of these investigations was to “send a strong message that theft from federal health care programs will not be tolerated.”

The 2018 OIG Medicaid Fraud Report disclosed 67 doctors, 402 nurses and 40 pharmacy services that had defrauded U.S. taxpayers by way of Medicare of Medicaid fraud.  For each $1 spent on the underlying investigations to uncover these fraudulent criminals, more than $4 was recovered.

Were Any Nursing Homes or ALFs Mentioned in the 2018 OIG Medicaid Fraud Report?

According to the 2018 OIG Medicaid Fraud Report, nearly $50 million in fraudulent dollars was recovered from nursing homes. Of that $50 million recovered, around $36.4 million resulted from 15 civil lawsuits and settlements.  The other $12.3 million came from 8 criminal convictions.  Of note, this number is significant increase from the 2017 amount of $1.4 million, evidencing a rise in fraudulent activities in 2018 long-term care facilities.

Sadly, this rampant fraud in nursing homes looks set to continue.  At the fiscal year end of 2018, there are currently 329 civil fraud and criminal investigations against nursing homes.

Medicaid fraud and medicare fraud at nursing homes

Is My Nursing Home/ALF Committing Fraud?

As an employee of a nursing home or assisted living facility, you are on the front lines of providing care for elderly, at need residents.  Sadly, not all facilities are created equal.  Some focus more on profits than providing adequate care.  If you see any of the following, your facility may be committing fraud.

  • Overcharging on pharmacy items, therapy or other services on medicare and medicaid patients
  • adjusting RUG scores on the MDS to make residents high acuity for medicare compensation, when that is not true
  • lying about the amount of therapy residents receive, or not providing therapy at all
  • coordinating resident’s medicare coverage with private insurers to allow private insurers to kick high acuity, high cost residents to medicare
  • providing unnecessary therapy or treatment to residents that do not need it
  • any other situation where homes are lying to medicare and medicaid to get more money than they should

If you suspect the facility you work at is acting fraudulently, it is important to speak with whistleblower attorneys that understand the nursing home/ALF industry.  If successful, you can recover up to 15-25% of what fraud the government uncovers.  Additionally, once the government understands a fraudulent practice, they can apply that knowledge to other facilities to prevent them from repeating it, helping improve care nationwide.

If you believe your employer is committing any fraudulent acts, call us today for a free consultations.


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