Medicare Compliance & Reimbursement
QUALITY OF CARE ISSUES CAN LEAD TO FALSE CLAIMS ACT PROBLEMS
Nursing homes can't afford to forget that perceived quality-of-care problems could leave them facing possible False Claims Act charges. U.S. Attorney Patrick Meehan's office in Philadelphia has been particularly aggressive with these so-called "failure of care" cases, and on Aug. 28 Mary J. Drexel Home in Bala Cynwyd, PA became the eleventh nursing facility in eastern Pennsylvania to settle such charges. The 30-bed home agreed to pay the government $75,000 and set up a $25,000 fund to enhance the quality of care provided to residents. The feds maintained that Mary J. Drexel improperly billed Medicare and Medicaid for inadequate care in 2000-2001. The alleged problems involved resident care plans, nutrition, hydration, pressure ulcer management, falls, restorative therapy and pain management. Mary J. Drexel counters that "its conduct was at all times lawful and appropriate," according to settlement documents. In addition to the monetary penalties, the home also agreed to retain an independent third-party consultant to help it comply with the settlement agreement, and to submit to an HHS Office of Inspector General review of its corporate compliance program. Lesson Learned: Nursing homes beware: Fraud fighters remain willing to use the powerful False Claims Act in cases involving nursing home quality of care.
Medicare Compliance & Reimbursement
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QUALITY OF CARE ISSUES CAN LEAD TO FALSE CLAIMS ACT PROBLEMS
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