The government is turning the spotlight on fraud and abuse in the long-term-care industry, with two bills brewing in Congress and a new set of False Claims Act guidelines in the works.
The U.S. Justice Department, HHS' inspector general's office and HCFA are trying to compile guidelines for referring cases of gross neglect and abuse at nursing homes to state or federal prosecutors, the agencies confirmed last week.
The goal is to develop a coordinated approach to deal with what HCFA calls "egregious violations" of quality standards at nursing homes.
Federal prosecutors have already used the False Claims Act to wrest settlements from a handful of nursing homes, arguing that government health programs pay for quality care. Submitting claims without providing quality care constitutes fraud, they argued.
As federal officials hammer out the guidelines, they are including providers in the dialogue. They have not set a deadline for developing the guidelines.
Meanwhile, Reps. Jim Davis (D-Fla.) and Mike Bilirakis (R-Fla.) are pushing a bill that would prevent nursing homes from evicting Medicaid patients and replacing them with higher-paying, privately insured patients. Lawmakers introduced a similar bill in the Senate.
At least one nursing home group, the American Health Care Association, supports that effort. The AHCA is an umbrella group representing more than 11,000 subacute and long-term- care facilities.
The proposed legislation "lays out a policy and process which are clear to both providers and residents as to when a discharge may occur," said Kelley Schild, an administrator at Floridean Nursing and Rehabilitation Center, Miami, in her testimony before Congress on behalf of the AHCA.
The legislation is a response to a Tampa, Fla., case in which a for-profit nursing home was charged with evicting Medicaid residents.
In another legislative maneuver, Rep. Jerry Weller (R-Ill.) late last week proposed a bill that would require criminal background checks on all nursing home employees to ensure residents' safety.
The American Association of Homes and Services for the Aging, a not-for-profit nursing home group, supports the idea but wants the government to pay for the background checks.
"A lot of our members are small nursing homes, and while they want to do this, it's yet another cost for them," said AAHSA spokesman Scott Parkin.
The bill should cover all providers, not just nursing homes, Parkin added. "This is an issue for everybody, including hospitals," he said.