Feds recover $10 million in incorrect Medicaid payouts

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The Medicare payment system for SNFs has become increasingly broken, a report states.
The Medicare payment system for SNFs has become increasingly broken, a report states.

Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.

The majority of the recoveries were civil fraud settlements or judgments, according to a report from the Department of Health and Human Services Office of the Inspector General. The agency compiled results from fraud control units, which exist in all but one state. They investigate alleged false claims, as well as abuse and neglect.

Three cases led to $8.3 million being recovered, report authors noted. Fourteen criminal fraud convictions of nursing facilities brought in another $1.1 million. There were 11 “other” long-term care facilities convicted of fraud, which brought in $340,500.

Six civil abuse and neglect cases citing nursing homes accounted for roughly $770,000 being recovered, and 10 abuse and neglect convictions brought in $155,000.

Separately, certified nursing assistants were cited in 75 abuse and neglect convictions, which brought just under $40,000 in recoveries. “Theft of patient funds” cases involving CNAs netted $117,000.

States' Medicare Fraud Control Units could be receiving too few fraud reports from Medicaid managed care organizations, report authors said. 

Rapid growth of managed care organizations could bring strengthened fraud-detection efforts, investigators noted.

The $10 million in recoveries is a miniscule percentage of total Medicaid spending, the American Health Care Association's Amy Mendoza told McKnight's. Based on government figures, Medicaid outlays for nursing homes and continuing care retirement communities totaled about $47 billion in 2013, according to Mendoza, senior manager for public affairs at AHCA.


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