Patient Dumping

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52342343 - nurse taking care of sick elderly patient at home

When hospitals or other medical care facilities release patients to the streets instead of putting them in touch with proper social services it’s called patient “dumping.” (You may remember this recent case of a woman who was spotted wandering a Baltimore street in only a nightgown and socks on a cold winter night.)  Something similar occurred in Hagerstown, Maryland, but on a much broader scale. The former owner of a nursing home in the area agreed to settle a lawsuit with the state attorney general’s office regarding allegations of Medicaid fraud involving more than 1,000 evictions.

Before you learn more about this case, let’s take a look at the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires individuals who visit an emergency medical facility to be stabilized and treated, regardless of whether they have insurance or the ability to pay. (This law is commonly referred to as the “anti-dumping” law, designed to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without providing a medical exam to ensure they were stable to transfer.) Even though the law was enacted by Congress in 1986, it remained an unfunded mandate. In 2000, Congress made EMTALA enforcement a priority and began issuing penalties for violation of the Act.

Today’s fraud article explains that over a 17-month period, the healthcare company that owned the Hagerstown nursing home issued approximately 1,061 eviction notices to residents of its five facilities. (During the same time, 225 other licensed nursing facilities in the state issued a total of less than half that number. I’m sure that raised a red flag.) The story goes on to say that the unsafely evicted nursing home residents were exposed to unsafe conditions when dumped in “homeless shelters and predatory unlicensed facilities.” (That paints a very clear picture that the owners of these facilities only cared about their bottom line. Essentially, they were pushing out the Medicaid patients to make room for those who could pay more.)

When the 206-bed facility in Hagerstown closed, another 150 residents had to be relocated. At that time, the nursing home was not allowed to accept payment from Medicaid or Medicare due to allegations of patient “dumping” and the submission of false claims to Maryland’s Medicaid program.

The settlement reached in the lawsuit ensures that the operator of the Hagerstown nursing home will no longer be allowed to operate nursing facilities in Maryland. The company that owned the five facilities must also pay $2.2 million to the attorney general’s Medicaid Fraud Control Unit to dismiss the allegations of Medicaid fraud. (The settlement, which does not serve as an admission of liability, also dismisses claims against the company and the former administrator at the Hagerstown facility.)

While the facility was reopened under new ownership in 2018 and now has new residents, you can’t help but wonder what happened to the more than 1,000 vulnerable residents who were evicted from their home. Thanks to the Medicaid Fraud Control Unit, the healthcare company at the center of this controversy will no longer be able to violate the civil rights of vulnerable Medicaid beneficiaries who deserve to be treated with respect.

Today’s “Fraud of the Day” is based on an article entitled, “Nursing home settlement involves former owner of Hagerstown facility,” published by Herald-Mail Media on October 30, 2018.

BALTIMORE — The former owner of a nursing home north of Hagerstown was the defendant in a lawsuit settled last week with the state attorney general’s office.

NMS Healthcare agreed to pay $2.2 million to the attorney general’s Medicaid Fraud Control Unit, and the company and its owner, Matthew Neiswanger, are prohibited from operating in Maryland, according to the settlement.

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.