Greatest fraudsters of Medicaid are nursing and home health aides OIG says

The Inspector General for Health and Human services reports that one third of Medicaid fraud criminal convictions the Feds obtained last year involved home health aides.

Thirty percent of the 2014 cases involved home health aides, while certified nursing aides were culprits in 9% of convictions. Next were medical support services workers (7%), the report found. All told, Medicaid Fraud Control Units achieved 1,318 criminal convictions in fiscal 2014, compared to 1,344 a year earlier.

Over two-thirds (73%) were for fraud, and 27% were for patient abuse and neglect, the OIG reported.

Recoveries in civil cases, meanwhile, increased substantially, to about $1.7 billion.

Certified nursing aide convictions, meanwhile, were predominantly related to cases of patient harm, submitting claims for services that were never provided and submitting fraudulent time sheets for hours worked, the OIG found. The majority of home health aide convictions were related to fraudulent claims for services never provided, the watchdog agency added.

MFCUs have authority to investigate patient abuse only in Medicaid-funded facilities, such as nursing homes, assisted living facilities and hospitals.

Jeffrey Newman represents whistleblowers