The Department of Justice released some numbers Thursday that should give more than a few providers cause for concern. According to these federal officials, False Claims Act-related settlements and judgments topped an alarming $2.68 billion last year.
For those unfamiliar, the law is designed to deter individuals and entities from submitting fraudulent payment claims to the government. It can also be used to snare operators who might deliver unnecessary or harmful services. Like, for example, rehab care.
“Protecting taxpayer dollars from fraud and abuse is of paramount importance to the Department of Justice – and these enforcement figures prove it,” said Acting Associate Attorney General Benjamin C. Mizer.
More than $2.3 billion of the settlements and judgments resulted from lawsuits filed under the law’s qui tam provisions — either by the government or whistleblowers. Congress substantially strengthened the statute in 1986. Since then, recoveries have topped $75 billion. Given those numbers, you can safely bet this effort will not be going away any time soon.
So, care to guess who the biggest culprits are? Yep, healthcare providers – including skilled care facilities. In fact, more than $1.8 billion of the recovered funds involved healthcare providers.
The department specifically cited one operator: New York-based Saratoga Center for Rehabilitation and Skilled Nursing Care. Its owners agreed to pay $7.1 million to resolve allegations that the facility delivered worthless services that caused medication errors, unnecessary falls, and pressure ulcers. Moreover, the 257-bed SNF was in such bad shape that it did not consistently maintain hot water, have an adequate linen inventory, or dispose of solid waste.
To say the feds are keeping a closer eye on you is probably a bit of an understatement. And this heightened scrutiny comes as some insiders are predicting unprecedented chaos related to Minimum Data Set billings.
Some fear that more than a few operators are submitting MDS data that is either incorrect, incomplete or unsubstantiated.
These deficiencies could lead to providers not receiving reimbursement for legitimate care, due to inaccurate documentation.
As for the worst-case scenario? How would you like to be featured in the DOJ’s next update?
For long-term care professionals, double-checking billings to ensure accuracy and compliance has never been more critical. Nor has the failure to do so been more dangerous.
John O’Connor is editorial director for McKnight’s. Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
