Efforts by state Medicaid Fraud Control Units resulted in a total of 17 criminal convictions and $265,040 in criminal case recoveries related to assisted living in fiscal year 2022, 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 16 criminal convictions and recoveries of $264,782 during the year. Investigations of Medicaid fraud in assisted living by the MFCUs in FY 2022 led to one criminal conviction and criminal case recoveries of $258, plus one civil settlement or judgment with recoveries of $2,575, the report noted.
At the end of the fiscal year, 250 criminal cases and 12 civil cases related to assisted living resident abuse or neglect remained open, according to the OIG, and 34 criminal cases and 19 civil cases involving assisted living-related fraud remained open.
The report also details abuse, neglect and fraud cases and outcomes related to numerous other types of facilities, programs and providers.
As in previous years since 2018, significantly more convictions for fraud involved personal care services attendants than any other provider type, according to the OIG. Fraud convictions involving PCS attendants accounted for 44% of total fraud convictions.
Meanwhile, convictions of nurse’s aides and of nurses or physician assistants for abuse and neglect were significantly higher than for any other provider types, the agency said.
Overall, MCFUs reported a total of 1,327 convictions (946 for fraud and 381 for abuse or neglect), 553 civil settlements and judgments and $1.1 billion in recoveries ($641 million in civil recoveries and $416 million in criminal recoveries) during the fiscal year, the OIG said. The number of convictions was an increase over the past two years but still lower than the 2019 level, the agency said. As a result, however, more than 1,000 (1,018) individuals or entities were excluded from federally funded health programs.
MFCUs operated in all 50 states, Washington, DC, Puerto Rico and the US Virgin Islands.
