New York State Gets $2.5 Million in Medicaid Fraud Case
By WINNIE HU
For-Profit Nursing Home Accused of Medicare Fraud
Yet another national, for-profit nursing home chain, Life Care, is being sued by the Justice Department over allegations of overbilling Medicare. Life Care is accused of billing nearly 68 percent of its Medicare rehabilitation days at the highest level, nearly twice the national average of 35 percent. CBS This Morning has spent months examining Life Care’s rehabilitation services and claims. It recently presented a scathing report, based in part on statements by at least a half dozen former Life Care employees.
A former assistant manager speech therapist at multiple Life Care locations told CBS This Morning that she eventually quit the facility because she felt that its insistence on unnecessary rehabilitation services was detrimental to the health of the nursing home residents. By the time she left, she said, nearly 40 percent of her work was neither reasonable nor necessary. In addition, she said, in many cases the nursing home would simply refuse to let patients leave, because they wanted to continue to bill Medicare for services!
In another piece of evidence, the entire rehab staff at the Life Care Center of Estero in Florida signed a letter to the boss which read, in part, “we have been encouraged to maximize reimbursement even when clinically inappropriate…”
There are six Life Care Centers in Kentucky: Laurel Creek Health Care Center, in Manchester; Life Care Center of Bardstown, in Bardstown; Life Care Center of La Center, in La Center; Life Care Center of Morehead, in Morehead; Mountain View Health Care Center in Elkhorn City and Parkview Nursing and Rehabilitation Center in Paducah. According to the CMS website, Life Care Center of Bardstown and Parkview Nursing and Rehabilitation each had three stars on their latest inspection report – that’s average. Life Care Center of La Center and Life Care Center of Moreshead both had two stars – below average. And Laurel Creek Health Care Center and Mountain View Health Care Center both received only a single star and are rated as much below average.
In general, studies show that for-profit nursing homes provide fewer staffing hours and a lower quality of care than nonprofit or government-run nursing homes.
Unfortunately, Life Care Centers is not the only nursing home chain being suspected of overbilling Medicare. The most recent report from the U.S. Department of Health and Human Services inspector general found that industry-wide, a quarter of all Medicare payments to nursing homes are made in error. When nursing homes charge for services they don’t provide, they increase the cost of Medicare and Medicaid to the taxpayer. These programs are already overextended. Fraud puts them in even more jeopardy. Equally seriously, if nursing home residents are given services they don’t need, it can make them uncomfortable, confused or disoriented. It can even endanger their health. The patients’ records are also likely to be inaccurate, which may cause doctors to misdiagnose them later.
Nursing homes have an obligation to provide responsible care to patients who need it – and not offer unnecessary services to patients simply so that they can charge more money. Keeping seniors in a nursing home when they are ready to be discharged simply to get more funds out of Medicare is unconscionable.
Winter Haven Nursing Home Aide Is Charged in Tax Return Fraud Case
Published: Sunday, May 26, 2013 at 11:28 p.m.
Last Modified: Sunday, May 26, 2013 at 11:28 p.m.
WINTER HAVEN | Deputies jailed a 23-year-old woman Friday who is accused of using the personal information of 13 nursing home residents to file fraudulent income tax returns.
Portia Charlton, a nursing assistant, was arrested during a traffic stop in Bartow. She remained jailed Sunday without bond.
Charlton formerly worked for Palm Garden of Winter Haven, where the victims lived, her arrest report says. She stopped coming to work in March 2012, two days after deputies searched her home at 3870 Horizon View Loop in Lakeland and found a notebook listing the names, birth dates and Social Security numbers of more than 100 people.
Dollar figures were written next to each name, indicating how much was obtained using the person's information, an arrest report said.
The arrest report said Charlton led the Internal Revenue Service to lose about $69,000.
Charlton became a suspect in the crime following a larger Sheriff's Office investigation into tax fraud in 2012. Her charges include scheming to defraud, aggravated white-collar crime and grand theft.
Deputies are still searching for her father, Norman Vince Charlton, 49.
He is wanted on federal charges of aggravated identity theft, theft of government property and conspiracy. Deputies believe he's in the South Florida area.
[ Matthew Pleasant can be reached at 863-802-7590. ]