As healthcare consumers, we rely on the government to protect our loved ones from unscrupulous caregivers. Each year the US Department of Health and Human Services compiles evidence from assisted living facilities across the country. The HHS has recently released its Medicaid Fraud Control Units Fiscal Year 2015 Annual Report. Think of it as an annual report card for assisted living fraud and abuse.
How assisted living facilities across the country fared
The report revealed an increase in criminal convictions. In fact, 2015 saw the highest number of convictions. There were 1,553 criminal convictions reported by all types of facilities studied.
Breaking down convictions according to caregivers
Nearly one third of convictions involved personal care service attendants, who provide most of the hands-on care. The remainder of the convictions were for assisted living fraud. An example of fraud is when caregivers bill for care not given, such as when an assisted living resident temporarily stays in a hospital but continues to receive bills for assisted living services. Almost half of the fraud convictions involved unlicensed providers. The report also highlighted that civil settlements and judgments are slightly down, which was due to a decrease nationally.
How Ohio facilities fared
In 2015 Ohio had 986 open fraud investigations, which resulted in 16 civil settlements or judgement. Of the 432 cases open to investigate abuse or neglect, there were only 27 criminal convictions.
Is it enough?
Based on these numbers, investigations into abuse and neglect are resulting in only a very small fraction of convictions. That is troubling because our seniors can be such a vulnerable population. It makes you wonder if we’re devoting enough resources to investigating claims of abuse in assisting living.
Certainly, requiring assisting living facilities to operate in compliance with federal regulations (like nursing homes must do) would make a good first step. But as I have discussed before, strong and sustained lobbying efforts have so far prevented that much-needed oversight.