Efforts by state Medicaid Fraud Control Units resulted in a total of 19 convictions and $168,991 in recoveries related to assisted living in fiscal year 2016, according to a new report from the Department of Health and Human Services Office of Inspector General.
Assisted living resident abuse or neglect investigations by the units led to 17 criminal convictions and recoveries of $65,735 during the year. The report called out one neglect conviction involving the owner of an unlicensed residential care facility who did not staff the facility at night, thereby putting residents in potential danger. The facility owner was sentenced to five years in state prison and was ordered to pay $21,000 in fines, according to the OIG.
Investigations of fraud in assisted living by the MFCUs in FY 2016 led to two criminal convictions and recoveries of $9,380, plus one civil settlement or judgment of $93,876, the report noted.
At the end of the year, 191 criminal cases and one civil case related to assisted living resident abuse or neglect remained open, according to the OIG, and 40 criminal cases and 14 civil cases involving assisted living-related fraud remained open.
The report also details abuse, neglect and fraud cases and outcomes related to other types of facilities as well as programs and providers. Personal care services was the largest category of convictions; 35% of total convictions involved PCS attendants, representatives of PCS agencies or other home care aides, the OIG said.
The second-largest category of convictions in FY 2016 involved nurses; 11% of total convictions were of licensed practical nurses, registered nurses, physician assistants or nurse practitioners, according to the report. Another 10% of convictions involved nurse aides.
Overall, MCFUs reported a total of 1,564 convictions, 998 civil settlements and judgments and almost $1.9 billion in criminal and civil recoveries during the year, the OIG said, adding that the number of civil settlements and judgments marked a five-year high.
The District of Columbia and all states except North Dakota have MFCUs.