Recent Study Suggests For-Profit Nursing Homes in Illinois and Nationwide are More Likely to Overcharge Medicare While Neglecting Seniors

A study recently published by the nation’s Department of Health and Human Services reportedly found that skilled nursing facilities throughout the nation overcharged the federal Medicare system about $1.5 billion in 2009. According to data compiled by Bloomberg News, approximately 30 percent of Medicare claims submitted by for-profit nursing homes were for patient treatments that were either unnecessary or never received. In contrast, only around 12 percent of such claims submitted by non-profit facilities were reportedly deemed improper. In 2010, a similar study found that for-profit nursing homes were twice as likely as non-profits to bill Medicare at the highest possible rate for residents with similar medical issues and needs.

A report released in 2012 by the Medicare Payment Advisory Commission (MEDPAC) claims that for-profit healthcare providers currently dominate the nation’s medical services industry. MEDPAC data suggests that about 33 percent of all nursing home revenues come from the federal Medicare program. An additional 50 percent is reportedly funded by Medicaid insurance for the poor. According to MEDPAC, for-profit skilled nursing facilities enjoy a 20 percent profit margin on all Medicare residents. In 2010, 78 percent of the approximately $105 billion in skilled nursing industry revenues were purportedly paid to for-profit homes.

The Alliance for Quality Nursing Home Care, a nursing home trade group, claims that nursing homes employ in excess of $1.6 million Americans. Still, the nation’s 10 biggest for-profit skilled nursing facility companies allegedly employed nearly 40 percent fewer registered nurses than non-profit facilities between 2003 and 2008. In addition, the same companies also purportedly received almost 60 percent more deficiency citations following federal inspections. A spokesperson for the American Health Care Association, Greg Crist, stated for-profit nursing homes have increased the number of registered nurses employed since 2009. Crist also claims a number of initiatives designed to increase quality were put into place at many facilities last year.

The pressure to reduce personnel expenses and increase federal insurance payments is reportedly quite high at many for-profit skilled nursing facilities. University of California, Los Angeles Law Professor Jill Horwitz stated for-profit nursing homes are also more likely to push legal boundaries in order to pursue higher revenues. As a result, civil and criminal cases filed by federal prosecutors against nursing homes throughout the nation reportedly increased by about 60 percent between 2008 and 2012.

The bulk of Illinois skilled nursing facilities receive Medicare and Medicaid funds. This means they are considered certified nursing homes. All certified nursing homes throughout the state are required to adhere to both Illinois and federal laws and regulations. The Illinois Nursing Home Care Act required skilled nursing facilities to increase staff numbers to 2.5 hours of direct care staffing for every skilled care resident by July 1, 2010. Additionally, the law mandates that all nursing home facilities in Illinois must provide 3.8 hours of direct care staffing for every patient by January 1, 2014.

Sadly, inadequate staffing levels are a common factor in nursing home abuse or neglect in Illinois and nationwide. Intentionally employing an insufficient number of healthcare workers in order to increase profits is a recipe for disaster. If you feel your friend or loved one was the victim of nursing home abuse or neglect, you are advised to discuss your concerns with a skilled lawyer.

If you have concerns over the quality of care your family member received at a skilled nursing facility in Illinois, you should contact the experienced attorneys at Abels & Annes, P.C. Our hardworking Chicago area nursing home abuse and neglect lawyers are available day and night to help you protect the rights of your elderly and disabled loved ones. For a free consultation with a hardworking attorney, do not hesitate to give Abels & Annes, P.C. a call at (312) 475-9596 or contact us through our website.

More Blogs:

Study Claims Disrespect is Number One Factor in Nursing Home Staff Turnover Rates in Illinois and Nationwide, Illinois Nursing Home Abuse Lawyer Blog, January 5, 2013
Illinois Ranks Third in Nation for Suspended Federal Payments Over Serious Nursing Home Violations, Illinois Nursing Home Abuse Lawyer Blog, January 2, 2013
Additional Resources:

For-Profit Nursing Homes Lead in Overcharging While Care Suffers, by Peter Waldman,

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