On March 30, the Department of Justice (DOJ) announced a major new initiative to target quality of care and fraud and abuse in elder care by forming 10 Elder Justice Task Forces throughout the United States. The DOJ intends to build these task forces on interdisciplinary teams – including Health Care Fraud Enforcement Action or HEAT Teams – already at work in several districts across the country. The teams include representatives from the U.S. Attorneys’ Offices, state Medicaid Fraud Control Units, local prosecutors’ offices, the Department of Health and Human Services, state Adult Protective Service agencies and other law enforcement. As with similar efforts, these multifaceted teams are designed to foster information sharing and cooperation among the myriad of agencies tasked with enforcing quality of care, billing and fraud and abuse laws and regulations.
While it’s unclear at this time exactly what impact these teams will have, the DOJ has explicitly identified nursing facilities that provide “grossly substandard care” as the primary target of this effort. When he announced this initiative , Principal Deputy Assistant Attorney General Benjamin C. Mizer, specifically referenced the 2014 settlement between Extendicare Health Services Inc., the DOJ and eight states. That settlement resolved allegations that Extendicare billed Medicare and Medicaid while failing to have a sufficient number of skilled nurses to care adequately for its residents, failed to provide adequate catheter care to some of its residents, and failed to follow the appropriate protocols to prevent pressure ulcers and resident falls. In addition to paying back $38 million to the government, Extendicare was required to enter into a five-year company-wide Corporate Integrity Agreement and engage an independent Quality Monitor to oversee the quality of its skilled nursing care.
This announcement only reinforces the government’s focus on skilled nursing care, which has increased with the growth of post-acute care spending. According to MedPAC’s June 2015 Data Book, skilled nursing facilities accounted for approximately half of Medicare’s $59.4 billion post-acute care expenditures in 2013. The DOJ has brought numerous False Claims Act cases against skilled nursing providers. Traditionally, those actions have focused on allegations of fraud and overbilling, while state authorities have focused on issues of quality of care. These teams are designed to bridge that divide and increase the amount of information shared between these typically siloed regulatory regimes. The districts where these teams will be operating include the Middle District of Tennessee in Nashville, the Western District of Kentucky, the Northern District of California, the Northern District of Georgia, the District of Kansas, the Northern District of Iowa, the District of Maryland, the Southern District of Ohio, the Eastern District of Pennsylvania, and the Western District of Washington.