N.Y. targets Medicaid overpayments: nursing home operators to repay funds. (News Fronts).

FOUR NURSING HOMES IN THE LONG ISLAND and New York City areas have agreed to repay more than $930,000 for having overbilled the Medicaid program, according to New York Attorney General Eliot Spitzer.

The Attorney General's Medicaid Fraud Control Unit (MFCU) found that the nursing homes had routinely billed Medicaid for reserved beds when their vacancy rates exceeded 5 percent.

Medicaid allows a nursing home to reserve a bed for a recipient and bill for that bed for up to 20 days when that recipient is temporarily hospitalized, but only if the nursing home meets certain conditions. On the first day of the Medicaid recipient's absence, the facility's vacancy rate must be no more than 5 percent or 15 beds, whichever is less.

The four nursing homes and their amount of repayment are: Townhouse Extended Care Center, Uniondale ($395,679); Nassau Extended Care Center, Hempstead ($322,104); Throgs Neck Extended Care Center, the Bronx ($150,797); and Park Avenue Extended Care Center, Long Beach ($66,187). No criminal charges have been brought against any of the four facilities.

Inflated rates

Following a separate investigation by the MFCU, Stanley and Judith Dicker, owners of nursing homes in Queens and the Hudson Valley, have agreed to repay more than $11 million, including interest, for Medicaid overpayments occurring between 1996 and 2001.

The Dickers own and operate the Hillside Manor Rehabilitation and Extended Care Center in Jamaica Estates, Queens, and the Hudson Valley Rehabilitation and Extended Care Center in Highland, N.Y. Each facility operates a long term home health program.

The MFCU's statewide review of home care providers found that in 1994, the Dickers began withdrawing substantial sums of money classified as "management fees" from their nursing homes. Although these fees were deemed non-reimbursable administrative expenses, a percentage was erroneously factored into rates billed for therapists, nurses, and aides associated with the Dickers' home health programs. Rates were thereby improperly raised from $13 to $26 per visit.

Between 1996 and 2001, these inflated rates amounted to $9 million in Medicaid overpayment to the Dickers' long term home health care programs.

Kevin Ryan, a spokesman for the Attorney General's office, says it was the New York State Health Department that erred in computing the rates.

"When the Dickers submitted their nursing home cost reports, they noted that these were not reimbursable expenses," he says. "But somehow those expenses were then factored in when the health department put together a rate for the Dickers' home health program."

Hillside Manor Rehabilitation and Extended Care Center will repay $9,172,628 and the Hudson Valley Rehabilitation and Extended Care Center will repay $1,968,040. No criminal charges have been brought in this case.

According to Ryan, the MFCU's ongoing investigations have recovered more than $58 million in restitution over the past 3 years.

"The good news is that the providers are paying back the money," observes Dan Curran, a spokesman for the New York Association of Homes and Services for the Aging (NYAHSA). "The bad news is that the not-for-profits and providers in general are being tarred with the same brush as people who may have made mistakes."

Curran adds that NYAHSA is advising its members to "keep watching their Ps and Qs on their paperwork."

VIEW FROM THE HILL

Bill        Title

H.R. 4600   HEALTH Act
Liability


S. 1169     Home Health Nurse and
Home         Patient Act
Care



H.R. 4715   Nursing Home Staffing
Staffing     Improvement Act




S. 2570
Medicaid




S. 2490     Medicare Skilled
Medicare     Nursing Beneficiary
             Protection Act




H.R. 4030   Medicare/Medicaid
Regulation   Nursing Facility
             Quality Improvement
             Act




S. 2240     Seniors Safety Act of
Regulation   2002/Nursing Homes
             Resident Protection
             Act of 2002





S. 1054     Patient Abuse
H.R. 3933    Prevention Act
Regulation







Bill        Description

H.R. 4600   Makes a variety of reforms in medical
Liability    liability and litigation
             Sponsor: Rep. James Greenwood (R-Pa.)

S. 1169     Streamlines the regulatory process
Home         applicable to home health agencies
Care         under the Medicare and Medicaid
             programs.
             Sponsor: Sen. Russ Finegold (D-Wis.)

H.R. 4715   Requires HHS to set minimum staffing
Staffing     levels fur nursing homes. Reinstates
             the Boren amendment and increases the
             federal Medicaid match by 1.5%.
             Sponsor: Rep. Henry Waxman (D-Calif.)

S. 2570     Temporarily increases the federal
Medicaid     Medicaid match by 1% in all states
             for 18 months. Includes a temporary
             block grant to cover social services.
             Sponsor: Sen. Susan Collins (R-Maine)

S. 2490     Eliminates the statutory expiration
Medicare     dates for Medicare reimbursement
             add-ons for skilled nursing
             facilities.
             Sponsor: Sen. Robert Torricelli
             (D-N.J.)

H.R. 4030   Amends Titles XVIII and XIX of the
Regulation   Social Security Act with respect to
             reform of the federal survey and
             certification process for nursing
             facilities under the Medicare/
             Medicaid programs.
             Sponsor: Rep. Dave Camp (R-Mich.)

S. 2240     A bill to combat nursing home fraud
Regulation   and abuse, increase protections for
             victims of telemarketing fraud,
             enhance safeguards for pension plans
             and health care benefit programs, and
             enhance penalities for crimes against
             seniors.
             Sponsor: Sen. Patrick Leahy (D-Vt.)

S. 1054     To require nursing homes to conduct
H.R. 3933    criminal background checks on
Regulation   prospective employees through both
             state and federal law enforcement
             agencies.
             Sponsor (S. 1054): Sen. Herb Kohl
             (D-Wis.)
             Sponsor (H.R. 3933): Rep. Julia
             Carson (D-Ind.)

Bill        Status *

H.R. 4600   Introduced in House, referred
Liability    to Judiciary and Energy and
             Commerce committees

S. 1169     Introduced in Senate,
Home         referred to Finance Committee
Care



H.R. 4715   Introduced in House, referred
Staffing     to Energy and Commerce and
             Ways and Means committees



S. 2570     Introduced in Senate,
Medicaid     referred to Finance Committee




S. 2490     Introduced in Senate,
Medicare     referred to Finance Committee





H.R. 4030   Introduced in House, referred
Regulation   to Judiciary Committee






S. 2240     Introduced in Senate, referred
Regulation   to Judiciary Committee







S. 1054     S. 1054 Introduced in Senate,
H.R. 3933    referred to Finance Committee
Regulation  H.R. 3933 introduced in House,
             referred to Energy and
             Commerce and Ways and
             Means committees




SOURCE: AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING

* As of mid-July