Provider groups last week cautioned against a proposal to broaden the federal False Claims Act to prosecute nursing home quality deficiencies.
The American Association of Homes and Services for the Aging and the American Health Care Association said the U.S. Justice Department's enforcement of quality standards could conflict with HCFA's quality enforcement mechanisms.
Their comments followed by a week a conference held by the Justice Department, HCFA and the HHS' inspector general's office to refine the triumvirate's approach to prosecuting severe quality deficiencies as Medicare and Medicaid fraud (Oct. 26, p. 4).
The same week, Deputy U.S. Attorney General Eric Holder told a meeting of healthcare lawyers that the Justice Department was most concerned with cases in which providers' severe staffing cutbacks resulted in deficient care.
Following the meeting, the Justice Department said it will develop an action plan over the next few weeks.
The AAHSA, which represents not-for-profit nursing homes, and the AHCA, which represents for-profits and not-for-profits, said the danger of the Justice Department's involvement is in setting quality standards that conflict with HCFA's.
That may be particularly true since the Justice Department does not have HCFA's clinical expertise.
HCFA follows standards laid out under 1987 budget law, which are enforced by state survey and certification agencies. Those standards largely judge nursing home performance based on patient outcomes.
But the Justice Department, in prosecuting one quality-related case under the False Claims Act, applied its own standards that focus on the process of treating patients.
The department's action has pleased Sen. Charles Grassley (R-Iowa), chairman of the Senate Special Committee on Aging and a chief critic of the Clinton administration's nursing home enforcement policies.
"He really feels that the False Claims Act is a tremendous tool," said committee spokeswoman Jill Gerber.
