Efforts by state Medicaid Fraud Control Units resulted in a total of 16 criminal convictions and $241,798 in criminal and civil monetary recoveries related to assisted living in fiscal year 2018, according to an annual report released Monday by the Department of Health and Human Services Office of Inspector General.
By comparison, unit efforts involving nursing facilities led to a total of 32 criminal convictions, 36 settlements or judgments and more than $50 million in criminal and civil recoveries in 2018.
Assisted living-related total criminal and civil recovery amounts were greater than those of FY 2016 but less than those of FY 2017, which had seen a spike of 641% from the previous year.
During 2018, assisted living resident abuse or neglect investigations by the units led to 11 criminal convictions and recoveries of $104,691.
Investigations of facility-related Medicaid fraud in assisted living by the MFCUs in 2018 led to five criminal convictions and recoveries of $20,599, plus three civil settlements or judgments totaling $116,508 in recoveries, the report noted.
At the end of the year, 221 criminal cases and two civil cases related to assisted living resident abuse or neglect remained open, according to the OIG, and 34 criminal cases and nine 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 attendants and agencies were convicted for fraud more than any other provider type, accounting for 45% of total convictions, according to the OIG.
More convictions for abuse or neglect in 2018 involved certified nursing aides and other aides than any other provider type, accounting for 129 of the total 394 convictions for abuse or neglect (33%) in 2018, the report stated.
Overall, MCFUs reported a total of 1,503 convictions (1,109 for fraud and 394 for abuse or neglect), 810 civil settlements and judgments and $859 million in criminal and civil recoveries during the year, the OIG said.
The District of Columbia and all states except North Dakota have MFCUs.
