I recently read an interesting article that involved concerns expressed by the Long Term Care Industry over massive audits being conducted for a number of Pennsylvania Nursing homes. 

Though it can certainly be appreciated why the enormity of the task can be daunting, as these facilities must make available an enormous volume of records, the context of these audits can’t be ignored. The US government has released studies suggesting that $100 billion is lost every year by taxpayers on waste, fraud and abuse of Medicaid/Medicare funds.  Any and all efforts to stop this bad conduct should benefit everyone and bring the focus on the healthcare debate into an area that simply has not had enough attention.

In our own practice, we have exposed significant abuses in billing, including billing for treatment of nursing home residents when they weren’t even in the building, to charting that they provided and billed for care to residents who had already died. We have exposed owners for including in their Medicaid budget family members as employees who never show up for work, with many of these same owners reporting to the government that they personally worked for 4,000 hours in a year – when it is clear that this hasn’t happened.

The long and short of this analysis is that sadly many good nursing home owners must participate in this arduous process to help the government weed out and expose the few bad apples who simply refuse to place the welfare of their own residents over their own desire to increase profits – even when those profits come from fraudulently taking money from us, the taxpayers.