Medicaid fraud units recovered $10 million from nursing homes in 2013, annual report shows

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CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $75
CMS: Medicare rate will increase 2% in 2015, boosting skilled nursing facility reimbursements by $75

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in fiscal year 2013, according to an annual report issued Friday.

Nearly every state runs a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all these units. They investigate allegations of criminal and civil fraud, such as false claims, as well as allegations of abuse and neglect.

Civil fraud settlements and judgments accounted for the majority of nursing home recoveries last fiscal year, according to the report. These cases led to $8.3 million in recoveries. Criminal fraud investigations led to about $1.1 million being recovered.

Civil abuse and neglect cases represented about $771,000 in recoveries, and criminal abuse and neglect convictions resulted in roughly $155,000 being recovered, the report stated.

Pharmaceutical manufacturers were involved in the majority of civil settlements and judgments in FY 2013, including a record $1.5 billion settlement over Abbott Laboratories' marketing of the drug Depakote, according to the OIG document. Home health care aides were involved in the most criminal convictions (26%).

Total civil and criminal recoveries topped the $2 billion mark for the second consecutive year, the report found.

A lack of fraud reporting from Medicaid managed care organizations to MCFUs could mean that cases are slipping through the cracks, the report noted. As managed care organizations become more established, their fraud detection could become stronger, the authors surmised.

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