Not enough food. Little air conditioning
or heat. Roofs leaking to the point that barrels and plastic sheets were used
to catch rain water. Trash that piled up in dumpsters. Flies and rodents
everywhere, along with rampant mold and mildew.
These were just some of the horrible
conditions that elderly residents of three Georgia nursing homes lived under
for several years.
The primary culprit: the owner of these
homes who, despite having received more than $32.9 million in payments from
Medicare and Medicaid for residents’ care, elected to pocket much of the money
instead.
But he didn’t get away with it. Earlier
this month, George Dayln Houser was convicted in Atlanta of defrauding Medicare
and Medicaid. Houser’s accomplice and wife, Rhonda Washington Houser, pled
guilty last December.
To receive Medicare and Medicaid
payments, Houser agreed to provide his residents with a safe and clean physical
environment, nutritional meals, medical care, and other assistance. But as
complaints began to roll in from residents, family members, nursing home
staffers, and vendors hired to provide services, it became clear he had no
intention of doing so.
These complaints led to an investigation
by the FBI’s Atlanta office—in concert with the Department of Health and Human
Services’ Office of Inspector General and the Internal Revenue Service’s
Criminal Investigation. Evidence gathered by investigators and later introduced
at trial showed that the services Houser provided to residents were so deficient
that the judge determined them “worthless.” It was a precedent-setting case…the
first time ever a defendant was federally convicted at trial for submitting
payment claims for worthless services.
There were other deficiencies in the
homes as well, including:
Inadequate staffing: Houser failed to
maintain a nursing staff sufficient to take proper care of the residents.
Staffing shortages started plaguing the homes after Houser began writing bad
checks to his employees, causing many to resign. He also withheld health
insurance premiums from his employees but let insurance lapse for non-payment,
leaving many with large unpaid medical bills.
Failure to pay vendors: Houser didn’t
pay food suppliers or providers of pharmacy and clinical laboratory services, medical
waste disposal, trash disposal, and nursing supplies. Kind-hearted employees
often used their own money to buy milk, bread, and other groceries so residents
would not starve. They also brought in their own nursing and cleaning supplies
and washed residents’ laundry in commercial laundromats or even in their own
homes.
And while his residents and his
employees were suffering, what were Houser and his wife doing? Spending their
ill-gotten Medicare and Medicaid payments on hotel real estate investments, new
homes, vacations, luxury cars, new furniture, and nannies for their child.
Houser even gave money to an ex-wife…paying her a nursing home salary (even
though she never worked there) and buying her a million-dollar home in Atlanta.
Said Atlanta Special Agent in Charge
Brian Lamkin, “The level of greed and lack of compassion for others that was
seen in this case reflect the very reason why the FBI, in working with its many
and varied law enforcement partners, dedicates vast investigative resources to
combating health care fraud.”
And in this case, we were especially
happy to see that all three nursing homes were eventually shut down by the
state, and residents moved into better living quarters to get the care and
compassion they deserve.
Nursing
Home Fraud
When a nursing home bills Medicare and
Medicaid for services that aren’t provided or that fail to measure up to basic
medical standards, that’s not only exploitation, it’s fraud.
Here are some signs that could point to
fraudulent billing by nursing homes:
- Residents living in unsanitary, unsafe
environments.
- Residents looking malnourished and/or
dehydrated.
- Ghost-billing for patients who don’t
exist or who have died.
- Offers of free items or services to a
resident in exchange for a Medicare or Medicaid number.
- Upcoding (putting residents in
ultra-high billing categories reserved only for those needing highly
specialized care and rehabilitation).
- Using inferior medicine or medical
equipment for residents while billing for premium services.
- Billing for services and/or equipment
not provided.
If you are a nursing home employee or a
family member of a nursing home resident and suspect that your facility is
engaging in Medicare or Medicaid fraud, submit a tip to the Health and Human
Services’ Office of Inspector General or the FBI.
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