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Florida Medicare Fraud Investigation Cuts Harm Nursing Home Residents

Last year, Florida reduced the budget for its Medicaid fraud-busting unit, meaning it also missed out on millions in matching federal funds for the program.magnifyingglass2.jpg

Our Wilton Manors nursing home abuse attorneys know that these kind of services are vitally important in helping to reduce harm to nursing home residents, who otherwise risk being subjected to treatments, therapies and medication that they don’t need.

We’ve reported extensively in our South Florida Nursing Home Abuse Lawyers’ Blog about the dangers of imposing such unnecessary treatment on elderly patients. Cases across the country have resulted in fatalities.

The state’s Medicaid Fraud Control Unit is the agency in charge of investigating claims in which health care providers charge for services that aren’t necessary, or in some cases, aren’t even rendered.

A report issued by the Agency for Health Care Administration and the Florida Attorney General’s Office indicated that more than $630,000 was trimmed from the unit’s budget. That meant that it lost matching federal funds totaling nearly $2 million over the last fiscal year, according to the Palm Beach Post. In fact, the federal government provides the majority of the unit’s $16 million funding.

Of course, the attorney general’s office contends that this has had little to no impact on the reduction of fraud. However, we question that assertion when considering the following:
–There has been a nearly 10 percent reduction in the number of new cases opened;
–A 15 percent decrease has been reported in prosecution referrals;
–The Medicaid Program Integrity audits recovered 22 percent less this past fiscal year than the year before;
–There was a nearly 25 percent drop in the number of arrest warrants relating to Medicaid fraud.

The agency has about 240 workers, with 15 of those in West Palm Beach. However, 23 positions have remained unfilled as the state grapples with its deficit.

Even in difficult economic times, though, anti-fraud unit cuts seem to make little sense. That’s because it’s one of the few state programs that actually generates more money than it costs to provide. Last year, the program generated $23 million in revenue, an increase from the $17 million it raked in the year before.

Nationwide, the federal government has been able to recover more than $4 billion as a result of its Medicaid fraud efforts – in large part due to the bolstering of the False Claims Act, which allows the government to collect triple the amount a company fraudulently obtained. (If a whistleblower is involved, he or she will likely get a portion of those revenues in a type of civil case called qui tam.)

So while Florida was reducing its Medicaid fraud-fighting resources, the federal government was actually increasing its own – and making money off of it.

One case that illustrates why these efforts are so important was one that the FBI investigated last spring in Georgia. The owner/operator of a nursing home facility just outside of Atlanta reportedly neglected patients for years. They weren’t given enough food. They were denied heat and air condition. Barrels and plastic sheets were spread out to catch the rain water from leaking roofs. Trash was overflowing. Nurses and other staff were scarce. Insects, rodents, mildew and mold had taken over. And yet, the owner was receiving Medicaid payments in exchange for providing those individuals with a safe, clean home with proper meals and adequate medical care.

A complaint ultimately sparked an investigation that led to his and his wife’s arrests and subsequent convictions on federal charges of Medicaid fraud.

We understand budgets need to be reduced, but these are not the kind of services we can afford to cut.

Freeman, Mallard, Sharp & Gonzalez — 1-800-561-7777 for a free appointment to discuss your rights.

Additional Resources:
Florida’s Medicaid fraud fighting cuts cost state millions in matching money, report says, Jan. 4, 2013, By Charles Elmore, Palm Beach Post

More Blog Entries:
Nursing Home Abuse Reports Scoured By Media Nationwide, Jan. 26, 2013, Wilton Manors Nursing Home Abuse Lawyer Blog

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