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New York Nursing Home Caught in Medicare and Medicaid Fraud

A $600,000 settlement between the New York Attorney General and Elant, Inc. will not protect the Hudson Valley nursing home chain from criminal prosecution for Medicare and Medicaid fraud at its locations, which occurred between 2008 and 2012.

According to the article “Nursing home chain not protected from prosecution” in The (Middletown NY) Times-Herald-Record, the agreement came after a multi-year investigation by the attorney general’s office and other state agencies that accuse Elant of numerous illegal activities, including submitting false claims to the state’s Medicare and Medicaid programs.

The investigation showed that the nursing home staff openly discussed via email their plans to delay discharges so they could keep the daily resident count for each home, known as “census,” as high as possible. The attorney general’s office shared excerpts from the emails. One of these emails from a former executive to another read, “We need to slow discharges across the system. I will send the message to Goshen but please let the other buildings know.” Another from a senior executive was sent with the subject line “Census” and said, “As can be seen from this morning’s census report, we are down across the system. Please manage your census this week and whatever discharges can be avoided, please do so. Residents and families can be very obstinate.”

The state charged—and Elant admitted—that it developed a practice of delaying the discharge of patients who were clinically ready to leave. This was frequently against the patients’ wishes and without their informed consent. This meant the nursing home provided service to patients that they didn’t need, and then billed the state. Elant also acknowledged scheming to move long-term patients to one of its financially troubled nursing homes to improve its financial condition.

As part of the settlement, Elant has agreed to aggressive oversight, which usually includes the appointment of a compliance committee or a compliance officer, written procedures, and comprehensive employee training.

Reference: The (Middletown NY) Times-Herald-Record (December 18, 2015) “Nursing home chain not protected from prosecution”

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