State Medicaid Fraud Control Units had 384 criminal and civil cases open against assisted living communities at the end of fiscal year 2024, according to new information from the Department of Health and Human Services Office of Inspector General released Wednesday in conjunction with a report.
Of those open cases, 304 criminal cases and seven civil cases were related to resident abuse or neglect, and 54 criminal cases and 19 civil cases involved fraud.
Regarding closed cases, efforts by state MFCUs resulted in 21 criminal convictions and $155,466 in criminal case recoveries related to assisted living in FY 2024.
Assisted living resident abuse or neglect investigations by the units led to all of those criminal convictions and recoveries during the year. There was one settlement or judgment related to abuse or neglect, and recoveries related to abuse or neglect cases totaled $200,000.
Meanwhile, investigations of Medicaid fraud in assisted living by the MFCUs led to two civil settlements or judgments with recoveries of $449,941, the report noted.
Overall findings
The report also details abuse, neglect and fraud cases and outcomes related to numerous other types of facilities, programs and providers, among them nursing facilities and home health agencies.
Overall, 1,151 convictions were reported.
The number of fraud convictions involving personal care service attendants was considerably higher than any other provider type in FY 2024, at 298 convictions. Personal care attendants accounted for 36% of all fraud convictions during the year.
When it came to abuse or neglect, nurse’s aides (75) cases and nurses (62 cases) were the top two provider types for convictions in FY 2024.
MFCUs reported the highest amount of total criminal recoveries over the 10-year period in FY 2024, with recoveries increasing from $272 million in FY 2023 to $961 million in FY 2024. The jump, according to the report, mainly was due to multiple cases that were prosecuted in California, accounting for 53%, or $513 million, of the cases.
The number of civil settlements and judgments, 493, also increased in FY 2024 after a general decline over the previous 3 years, according to the report. Meanwhile, total civil recoveries dropped by more than half in FY 2024, to $746 million, after reaching a 4-year high of $984 million in FY 2023.
Pharmaceutical manufacturers accounted for more civil settlements and judgments than any other provider type in FY 2024, at 76. Hospitals and pharmacists accounted for the largest total amount of civil recoveries in FY 2024, at $60.1 million and $60 million, respectively.
Read the whole report here. The assisted living information is contained in the supplemental information released with the report.
Source: McKnights Seniorliving
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