South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

State and federal officials announced today a $550,000 settlement in a fraudulent medical billing case against Green Valley Pavilion of Smyrna.

Members of the Delaware Attorney General’s Office medicaid fraud control unit and the U.S. Attorney’s Office determined that some of Green Valley’s employees were altering patient charts in order to get more money from the Delaware Medicaid Program.

Because the investigation showed that none of the nurses personally profited from the scheme, state and federal prosecutors pursued Green Valley for restitution due to Medicaid. After months of negotiations, Green Valley agreed to pay more than a half million dollars.

“Caregivers have been sharply reminded of their responsibilities to their patients, and nursing home owners are on notice that they will be held responsible for the acts of their employees,” said Deputy Attorney General Dan MIller, the lead prosecutor in the case. “We have already seen a drop in the amount of questionable reimbursement requests submitted to the Medicaid program.”

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 U.S. Medicare Monday proposed a $690 million increase in payments to nursing homes. The 3.3-percent increase would go to nursing facilities that provide skilled nursing and rehabilitation care to Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services.

Under the new payment schedule, called the skilled nursing facility prospective payment system, the daily rate for room, board, medical care and other expenses would be increased. Current payments are based on a 1997 market basket, but the proposal would update rates using a 2004 market basket.

Hopefully, this increase will lead to more staff who are better trained.

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