Yesterday's Washington Post cites SEIU's role in discovering a possible case of Medicare fraud by California-based nursing home company North American Health Care (NAHC), which operates 35 nursing homes in four states. According to SEIU's research, confirmed by the Washington Post, NAHC may be falsifying patient records and overcharging Medicare by tens of millions of dollars each year.
Indeed, a number of former NAHC employees have testified to repeated orders to alter and falsify patient records. NAHC appears to be an industry leader in "upcoding" services provided to Medicare patients and charging Medicare the highest possible rates for resident care. Further research showed that:
- Nationally, the median nursing home bills 4.7% of its Medicare patient days in the two most expensive codes, yet NAHC homes bill an average of 67% of their Medicare days to these codes. This difference is particularly striking given the residents in NAHC homes are no more sick than state or national averages.
- NAHC's coding practices may be costing taxpayers at least an additional $114.26 per patient, per day.
- This apparent overcharging Medicare by shady coding practices adds up to a total cost of $27.2 million in 2008 and $98 million since 2002.
Putting a stop to this kind of pattern of fraud could begin to fulfill President Obama's promise of cost savings in Medicare through the reduction of waste, fraud, and abuse. A successful government investigation and prosecution of SEIU's findings could yield even greater recoveries for Medicare and significant savings for taxpayers. SEIU is calling on the U.S. Department of Health and Human Services (HHS) Office of the Inspector General to investigate these issues and, if confirmed, hold NAHC accountable for its actions.
