Industry Insights

DOJ Adds Increased Oversight to Nursing Homes

June 2016
Author:  Suzy Harvey

Suzy Harvey

Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
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Nursing homes and the long-term care (LTC) industry continue to be staggered by the rapid and sometimes drastic changes. On March 30, 2016, the U.S. Department of Justice (DOJ), along with the U.S. Department of Health and Human Services, Office of Inspector General, state Medicaid Fraud Control Units, Adult Protective Services and the Offices of the Ombudsman, announced the creation of 10 regional Elder Justice Task Forces. The 10 task forces will be located nationwide and hold nursing homes and LTC providers accountable for substandard care by bringing together a team of federal, state and local prosecutors, law enforcement and agencies providing services to the elderly. The task force will be charged with coordinating efforts when a provider fails to give Medicare and Medicaid residents the care they are entitled to, participating in joint investigations, sharing information and holding regular meetings to enhance efforts to protect the elderly.

In reaction to this regulatory measure, the American Health Care Association (AHCA) stated, “We support any efforts to improve overall care and weed out bad actors, but … [this] announcement mistakenly conveys that quality is on the decline.… Creating task forces under the guise of fraud and abuse is actually pointing a finger at a flawed Medicare payment system.” AHCA provider advocates view these task forces as “… a smokescreen aimed at finding cost cutting measures that would threaten life-improving post-acute and long term care services for millions of seniors.”

AHCA providers and other stakeholders support and are actively investigating comprehensive payment reforms that will allow for quality care at a lower cost. However, they consider the task force unnecessary, since the recently released Centers for Medicare & Medicaid Services (CMS) data shows that care deficiencies are down while quality is on the rise. As providers continue to navigate the changes in the upcoming months and years, they need to be conscious of the quality of care provided to their residents. Having a good rapport with the residents, their families and local ombudsmen will help nursing home and LTC providers offer quality care while remaining aware of problems before the DOJ task force walks through the front door.

LTC providers will continue assisting the elderly dependent on their services, despite CMS’ cost-cutting 10 regional Elder Justice Task Forces measure.

Contact your BKD advisor if you have any questions about this article or other LTC programs.

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