John O'Connor
John O’Connor

Any way you slice it, a ton of federal relief has been flowing into the senior living sector since COVID-19 arrived. An exact dollar amount may be impossible to determine. But by some estimates, Uncle Sam’s healthcare-related outlays nearly doubled to $2.4 trillion during the past year.

To be sure, such assistance hardly could have come at a better time. Many operators still are struggling to survive. Yet, given the massive amount of money flowing into this field, you can be sure of two things.

The first is that at least some of the funds have been and will be diverted to purposes that are, shall we say, questionable.

The second is that the government is going to step up its efforts to sniff out anything that smells even remotely of fraud or abuse.

So in the words of Batman’s nemesis Bane, “Let the games begin!” But this time, the usual cat-and-mouse routine may have a few new wrinkles.

For it appears the feds are upgrading some of the tools they will be playing with, according to a recent piece appearing in Employment Law360. In it, Foley & Lardner attorneys Matthew Krueger, Pamela Johnston and Michelle Freeman cite two new resources the feds will lean on: data analytics and specialized task forces.

Although we don’t know exactly where the Biden administration will focus its investigations, we have a pretty good general idea. As the authors note, the Department of Justice and the Department of Health and Human Services’ Office of Inspector General have laid out the following targets as being ripe for fraud and abuse:

  • COVID-19-related funding
  • Telehealth
  • Prescription drugs
  • Electronic health records
  • Cybersecurity
  • Elder fraud
  • Medicare Part C managed care

One way or another, senior living is affected by all seven.

As for how to better protect your organization when inspectors start looking under the hood, the authors have three suggestions.

One is to perform audits of provider relief funds, Paycheck Protection Program loans and other pandemic-relief funding your organization has received.

A second is to enhance your use of data analytics for monitoring and risk assessment.

Finally, revisit your policies, training and practices for encouraging and responding to complaints by employees, residents and others.

Do those three things, and you’ll probably have a lot less to worry about when the feds come a knocking. For by all accounts, that day is fast approaching.