Brooklyn, NY – An administrative law judge handed down a major decision on Nov. 4 that affects New York nursing homes subject to fraud investigations by the Office of the Medicaid Inspector General.
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In this case, Metropolitan Jewish Geriatric Center, a Brooklyn nursing home, appealed an OMIG directive to return $930,000 in Medicaid payments. The DOH administrative judge reversed that directive.
“If the decision had gone the other way, it would have given OMIG a green light to collect hundreds of thousands of dollars” from nursing homes, says Francis Serbaroli, a health care lawyer at Greenberg Traurig.
The case centered on the documentation that nursing homes need when they hold beds for their patients who are hospitalized but are expected to return. The judge wrote in his opinion that while OMIG alleges that the New York bed-hold program “is a veritable economic boon” to nursing homes, it “cannot retroactively reinterpret regulations that have not materially changed during the past several decades.”
Based on those regulations, nursing homes documented why they were holding a bed open by retaining census records and data on admissions and discharges. But OMIG also wanted them to produce discharge planning documents from hospitals, explains Matthew Fenster, a Greenberg Traurig health care attorney.
Nursing home providers contend that the ruling proves that Inspector General Jim Sheehan arbitrarily reinterpreted DOH’s longtime rules on bed holds. Mr. Sheehan said he has not yet completely reviewed the court record. For now, he said, it would be prudent for nursing homes to have “a basis for the conclusion a bed hold is appropriate.”
The headline should not say “fraud” case. This was not a case of fraud or an attempt at fraud. As the article clearly indicates Mr. Sheehan arbitrarily interpted the rules.
so the taxpayer get taken for a ride again ….. we should start teaching bankruptcy law in yeshivas and schools , since that will be the best job in the next few years as state and cities go bankrupt
Finally, some relief for Skilled Nursing Facilities. The DOH for some reason believed that due process and resonable thinking did not apply to Nursing Homes and continuously changed the rules on them thinking that no one would dare reverse there illogical reasoning.
score one for the little guy!!
Unfortunately, people who end up in a nursing home is not of their own choice. It’s either the family or the hospital that puts them there. In additions many families hire their own help if in their best interest to have the best care for their loved ones.
People are oblivious that with home care, even when on Medicaid you can keep your loved one at home even if they have severe medical issues. People in nursing home business were always and still are concerned in “what is in it for me”. They look to cut costs to help their profits grow. Some nursing homes are ancient and horrible, with beds from the 1960’s. Instead of hiring RN’s they hire LPNs and will have one RN overseeing as many as 6 floors. The nights are understaffed but the owners are living off the fat of the savings. It’s about time that we speak up and stand up for those who are helpless and forced to live in inhumane conditions!
Metropolitan Jewish is a non-profit. There is no owner making a killing.