Bloomberg News had an interesting article on a recent study by federal health care inspectors which said U.S. nursing home industry overbills Medicare at least $1.5 billion a year for treatments patients don’t need or never receive. That is incredible. The national for profit chains were the worse offenders. 78 percent of $105 billion in revenues went to for-profits in 2010, up from 72 percent in 2002. The emergence of national for profit chains is fueling waste, fraud and patient harm in the $2.8 trillion U.S health care sector.
Thirty per cent of claims sampled from for- profit homes were deemed improper, compared to just 12 percent from non-profits, according to data Bloomberg News obtained from the inspector general’s office of the U.S. Department of Health and Human Services.
"The November study that found $1.5 billion in improper nursing-home bills — equivalent to about 5 percent of total Medicare outlays to the facilities — was by the U.S. Department of Health and Human Services office of inspector general. It followed a 2010 OIG report that found for-profit nursing homes were nearly twice as likely as nonprofits to bill Medicare at the highest rate for patients of similar ages and diagnoses."
Nursing homes employ more than 1.6 million workers, second only to hospitals in the health care sector, according to the Alliance for Quality Nursing Home Care, the trade group representing for-profit facilities. Most of these workers are certified nurse aides who get no health benefits and are paid minimun wage. Understaffing leads to burn-out, stress, and lashing out at residents.
"The 10 largest for-profit nursing-home chains employed 37 percent fewer registered nurses per patient-day between 2003 and 2008 — and received 59 percent more deficiency notices from government inspectors — than nonprofits did, according to a study published last year in the journal Health Services Research."
"At a nursing home in South Carolina owned by Life Care Centers of America Inc., an 80-year-old woman who couldn’t control her head or keep her eyes open was placed in a standing frame for 84 minutes of physical and occupational therapy just two days before she died — one in a number of Life Care overcharges for unnecessary care, according to civil fraud allegations filed in November by the U.S. Justice Department in federal court in Chattanooga."
In a civil complaint unsealed last month, U.S. prosecutors accused Life Care of billing Medicare for unnecessary and sometimes harmful treatments at its 230 nursing homes between 2006 and 2012.
This is what happens when for profit chains put profits over people.
Other blogs have discussed this report here and here.