Nursing facilities were among six provider types with the most patient abuse and neglect convictions tied to Medicaid than other provider types in 2023, as a whopping 841 criminal and civil patient and abuse complaints related to the sector – topping all other categories – are still open to investigation.
There are 238 open nursing home investigations tied to Medicaid fraud out of 16,833 among all provider types, according to a report issued by the Office of the Inspector General (OIG) on Thursday. It’s the latest in efforts by OIG to improve nursing home oversight and quality, and recover misappropriated funds.
OIG found that nursing homes had 36 patient neglect and abuse convictions last year in investigations done by Medicaid Fraud Control Units (MFCUs). Nurse aides, nurses, personal care (PCS) attendants, family members or guardians, and developmental disability facility settings were the other five named categories in the OIG report.
MFCUs recovered $1.43 million in Medicaid criminal convictions from nursing homes for patient abuse and neglect, and $9.34 million in Medicaid civil settlements and judgments for the space. For comparison, MFCUs recovered $9.41 million from assisted living facilities and $2.46 million from family members or guardians for the same types of conviction recoveries.
About $1.2 billion was recovered as a result of Medicaid convictions among all provider types, for both civil and criminal recoveries.
For the second year in a row, nurse aides and nurses had the most patient abuse and neglect Medicaid convictions at 56 and 52 respectively. The nurse category includes licensed practical nurses (LPNs), registered nurses (RNs) and other licensed nurses.
There were 42 instances where family members or guardians were responsible for such Medicaid convictions, and 30 convictions tied to developmental disability facility settings, OIG reported.
OIG found there were 1,143 Medicaid convictions in 2023, with 814 connected to fraud and 329 tied to patient abuse or neglect. The number of MFCU convictions decreased significantly in 2020, compared to pre-pandemic convictions.
About 850 individuals or entities were excluded from federally funded programs, and there were 436 civil settlements and judgments, according to the report.
“This report generally shows that results from MFCU activities are picking back up after slumping in FY 2020 but have not gone back to pre-pandemic levels,” OIG officials said in the report. MFCUs play a vital role in holding wrongdoers accountable for Medicaid provider fraud and protecting patients from abuse or neglect.”
The number of PCS attendants convicted of Medicaid fraud was significantly higher than any other provider type, OIG found, at 279 convictions. Nurses were the second highest in Medicaid fraud convictions at 66, followed by home health agencies at 43, ophthalmologists at 37 and mental health facilities at 36.
The amount of annual criminal recoveries over a 10-year period was between $173 million and $416 million, although 2017 and 2021 were outliers due to specific cases garnering large recoveries from MFCUs; the cases involved the owner of a laboratory and urine testing services.
And, despite a decreasing number of overall civil settlements and judgments, total Medicaid civil recoveries in 2023 reached a 4-year high, OIG found.
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