MEDICARE AND MEDICAID FRAUDS, PART 2 - HEARING BEFORE THE SUBCOMMITTEE ON LONG-TERM CARE, 94TH CONGRESS, 2ND SESSION, NOVEMBER 13, 1975

• NCJ Number: 61555
• Author(s): ANON
• Date Published: 1976
• Length: 71 pages
• Corporate Author: US Congress
• Sale Source: Superintendent of Documents, GPO; National Institute of Justice/
• Publication Type: Legislative/Regulatory Material
• Language: English
• Country: United States of America
• Note: ISSUED IN 9 PARTS.

Annotation

THIS SECOND SESSION OF SENATE HEARINGS ON MEDICARE AND MEDICAID FRAUD CONTAINED TESTIMONY ON ABUSES COMMITTED BY NURSING HOMES, WITH PARTICULAR REFERENCE TO MISUSE OF PATIENTS' FUNDS.

Abstract

FOLLOWING A BRIEF INTRODUCTORY STATEMENT, THE DIRECTOR OF THE MANPOWER AND WELFARE DIVISION OF THE U.S. GENERAL ACCOUNTING OFFICE SUMMARIZED A REVIEW OF CONTROLS EXERCISED BY THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (HEW) AND VARIOUS STATES OVER THE PERSONAL FUNDS OF MEDICAID PATIENTS IN NURSING HOMES AND INTERMEDIATE CARE FACILITIES. THE REPORT REVEALED THE FOLLOWING MAJOR DISCREPANCIES: SHORTAGES BETWEEN PATIENT LEDGER BALANCES AND BANK ACCOUNTS, CHARGES FOR MEDICAL SUPPLIES AND SERVICES THAT SHOULD HAVE BEEN INCLUDED UNDER ROUTINE CARE, RETAINED FUNDS BELONGING TO DECEASED AND TRANSFERRED PATIENTS, AND RETAINED INTEREST ON PATIENT FUNDS. THE WITNESS RECOMMENDED THAT HEW DEVELOP STRINGENT GUIDELINES REGARDING PATIENT FUNDS AND THAT STATES IMPROVE THEIR MONITORING SERVICES. A FORMER ILLINOIS DEPARTMENT OF PUBLIC AID OFFICIAL THEN TESTIFIED UNDER OATH CONCERNING INCIDENTS OF MEDICAID FRAUD THAT HIS DEPARTMENT HAD UNCOVERED BUT WAS UNABLE TO PROSECUTE BECAUSE OF POLITICAL PRESSURES. CITING PROBLEMS IN FEDERAL-STATE COOPERATION, INSUFFICIENT INVESTIGATIVE MANPOWER, AND AUDITING TECHNIQUES, THE WITNESS RECOMMENDED SEVERAL SOLUTIONS, SUCH AS THE USE OF COMPUTERS, COOPERATION WITH MEDICAL SOCIETIES, AND INCREASED MONITORING BY HEW. THE KANSAS ASSISTANT DISTRICT ATTORNEY GENERAL TESTIFIED THAT, ALTHOUGH KANSAS HAS REGULATIONS TO SUPERVISE NURSING HOMES CONDITIONS, IT LACKS THE NECESSARY STAFF TO CONDUCT REGULAR INSPECTIONS AND AUDITS. WHEN THE STATE CONSUMER PROTECTION AGENCY DID INVESTIGATE SELECTED HOMES, IT FOUND NUMEROUS ABUSES. THE PRESIDENT OF THE CALIFORNIA PHARMACEUTICAL ASSOCIATION DESCRIBED THE GENERAL PROBLEMS THAT PHARMACISTS ENCOUNTER IN DEALING WITH NURSING HOMES AND KICKBACK PRACTICES. THE ANONYMOUS STATEMENT OF AN ILLINOIS PHARMACIST ON FRAUDULENT ACTIVITIES IN THE STATE PUBLIC AID PROGRAM IS PRESENTED, AND THE APPENDIX CONTAINS A REPORT ON THE KANSAS NURSING HOME INDUSTRY. (MJM)