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

Chicago Sun-Times had a great article about how administrators in Illnois (like most states) do not get disciplined when  the administrators allow or permit abuse, neglect, or poor care at nursing homes.  Illinois nursing home administrators are rarely disciplined even though the state Health Department, which investigates nursing home care, refers dozens of cases a year to the agency in charge of meting out punishment.

From 2005 through 2009, the Illinois Department of Financial and Professional Regulation received 407 complaints from the state's health department. Only three resulted in discipline for nursing home administrators.  THREE OUT OF 407 COMPLAINTS. 

Advocates for nursing home residents say that's a sign of a broken system.  "Less than 1 percent is ridiculous," said Toby Edelman, an attorney with the nonprofit Center for Medicare Advocacy. "There should be more accountability on the part of the administrators."

The numbers were put together by a task force Gov. Pat Quinn formed after a series of assaults, rapes and murders in Illinois nursing homes. The task force is looking into why so few cases result discipline, said Michael Gelder, Quinn's senior health adviser. "We're absolutely very concerned about that," he said.

Advocates for nursing home residents are now watching to see whether Jamie L. Lloyd, administrator of Maplewood Care in Elgin, will be disciplined after a 21-year-old mentally ill resident sexually assaulted a 69-year-old woman at the home. Lloyd did not do a proper background check.  Had Lloyd checked, he would have discovered the former resident had an outstanding arrest warrant on felony battery charges.

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The George Washington University School of Public Health did a study about health insurance fraud.  Here are some interesting excerpts from the study:

In 2007, the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims.  The National Health Care Anti-Fraud Association (NHCAA) has estimated that, conservatively, 3% of all health care spending—or $68 billion—is lost to health care fraud. Other estimates by government and law enforcement agencies place fraud-related losses as high as 10% of annual health care spending; at this rate, the losses in 2007 alone –over $220 billion – would have been enough to cover the uninsured.

Medicare and Medicaid may be susceptible to fraud in part because many investigative reports on victims of consumer swindles suggest that financial fraud is not uniformly distributed across all households; instead, it disproportionately targets the elderly, women, minorities, the less educated, and the poor.  In other words, Medicare and Medicaid fraud may reflect the vulnerable nature of the populations that depend on the program rather than any failing on the part of either program.

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