Literature Review

Investigating Medicare hospice overpaymentsHospice News, by Jim Parker; 1/2/24As auditing activity by regulators continues to spike, hospices need to know how to conduct internal investigations to identify any potential improper payments.

Unlicensed Saratoga County nursing home operator to pay $650,000Times Union (Albany, NY)December 21, 2023Ballston Spa, NY—The unlicensed operator of a now shuttered Saratoga County nursing home is set to repay Medicaid $656,000 after an investigation by the state attorney general’s office and U.S. attorney for the Northern District of New York found years’ worth of fraud and resident neglect at the facility. 

Nursing homes still face data concerns, new audit saysTimes Union (Albany, NY)December 20, 2023Albany, NY—The state Department of Health largely failed to implement recommendations meant to improve infection control in nursing homes, according to an audit released by the state comptroller’s office on Wednesday. The audit came as a follow-up to a March 2022 audit by state Comptroller Thomas DiNapoli’s office that found data released by the Health Department “misled the public” and undercounted deaths in nursing homes. 

Steward Health Care hit with False Claims Act lawsuitHealthcare DiveDecember 20, 2023The federal government is suing Dallas-based Steward Health Care and its facilities, Steward Medical Group and Boston-based St. Elizabeth’s Medical Center, for violating the False Claims Act and a physician self-referral law, according to a Monday announcement. The complaint, filed in Massachusetts District Court, alleges Steward Medical Group improperly linked a lead cardiologist’s compensation with his referrals, leading the group to award him nearly $5 million in incentive-based pay—and violating physician self-referral rules, known as the Stark Law. 

Three found guilty of fraud in South Florida nursing-school ‘diploma mill’ trialMiami HeraldDecember 15, 2023Three people charged with playing crucial roles in a South Florida nursing-school “diploma mill” were found guilty by a federal jury Friday, after a three-week trial where prosecutors accused the defendants of corrupting the healthcare field. The defendants, a former registrar for the defunct Palm Beach School of Nursing and two recruiters from the northeast, were accused of selling fake transcripts and degrees to thousands of students for millions of dollars so they could qualify to attain licenses as nurses.

US Supreme Court refuses to hear fraud appeal for South Florida health care executive pardoned by TrumpSouth Florida Sun-SentinelDecember 11, 2023The U.S. Supreme Court on Monday refused to take up an appeal by a South Florida nursing-home operator whose 20-year prison sentence was commuted by former President Donald Trump after being convicted in what prosecutors called a “massive health care fraud scheme.” The Supreme Court rejected a petition by attorneys for Philip Esformes, who was found guilty in 2019 on 20 counts related to kickbacks, money laundering, obstruction of justice and conspiracy, according to court documents. 

UnitedHealth hit with Medicare Advantage marketing complaintModern HealthcareDecember 7, 2023Advocates for people with disabilities are calling on regulators [to] halt what they describe as misleading Medicare Advantage marketing by UnitedHealth Group. The Center for Medicare Advocacy, National Health Law Program, Disability Rights Connecticut and National Disability Rights Network wrote the Centers for Medicare and Medicaid Services, the Federal Trade Commission and other state and federal officials Thursday to protest UnitedHealthcare advertisements for Dual Eligible Special Needs Plans appearing in Connecticut. The ads target people with both Medicare and Medicaid and spotlight extra benefits from Medicare Advantage plans that state and federal laws already require, the groups wrote. “Unquestionably, this misleading advertising is intended to induce, and has induced, thousands if not tens of thousands of older adults and disabled low-income individuals we are charged with representing to sign up for UnitedHealthcare’s plan, having been led to believe this means they can get extra benefits,” the letter says. UnitedHealth Group did not immediately respond to an interview request.

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023Healthcare DiveDecember 4, 2023The HHS’ Office of the Inspector General is expected to recover more than $3.44 billion in fiscal year 2023 as a result of investigations into fraud and misspent funds in Medicare, Medicaid and other government health programs, according to the agency’s latest report.

A Broward hospice nurse stole from a widow-to-be. She’s living and licensed in New York