3 ms·

This is stunning in its scope and made me wonder in what other developed country is it even possible for a citizen to defraud its government of over 1 billion d

by dr_ 8y ago

This is stunning in its scope and made me wonder in what other developed country is it even possible for a citizen to defraud its government of over 1 billion dollars? The skilled nursing system in this country is broken, with no meaningful oversight other than an annual inspection which everyone knows is coming. Lengths of stay are unnecessarily long and the quality of care is unbelievably sub par. Despite all of this, fraud at this level is pretty astounding, and should serve as a wake up call for the government to more aggressively monitor all facilities, or outsource monitoring from the States to private agencies.

jamra 8y ago
Skilled therapy is changing though. PDPM doesn’t reimburse through the amount of therapy provided. It reimburses by the need of the patient. I believe nursing is included in that budget
- dr_ 8y ago
  that was what the RUGs were supposed to do, but it was easily gamed and I don’t see why this wouldn’t be either. The only advantage it offers, IMO, is that it allows patients with a greater variety of needs (like more nursing skill and less or no therapy) to receive care. For example, the end stage cancer patient who can’t withstand much therapy but isn’t ready to accept hospice.
anigbrowl 8y ago
You can run a company that has to pay $1.7 billion in fines for defrauding medicare and still be governor of Florida and (as of last January) a sitting US Senator: https://www.politifact.com/florida/statements/2014/mar/03/florida-democratic-party/rick-scott-rick-scott-oversaw-largest-medicare-fra/ https://www.politifact.com/florida/statements/2014/mar/03/fl...
- joe_the_user 8y ago
  Indeed, The phrase "Robber barons" from 19th century was hardly overstated. America is once again reaching a stage where a large enough fraud and criminality offers an exit strategy into the ruling class.

by dr_ 8y ago

jamra 8y ago

Skilled therapy is changing though. PDPM doesn’t reimburse through the amount of therapy provided. It reimburses by the need of the patient. I believe nursing is included in that budget

dr_ 8y ago
that was what the RUGs were supposed to do, but it was easily gamed and I don’t see why this wouldn’t be either. The only advantage it offers, IMO, is that it allows patients with a greater variety of needs (like more nursing skill and less or no therapy) to receive care. For example, the end stage cancer patient who can’t withstand much therapy but isn’t ready to accept hospice.

anigbrowl 8y ago

You can run a company that has to pay $1.7 billion in fines for defrauding medicare and still be governor of Florida and (as of last January) a sitting US Senator: https://www.politifact.com/florida/statements/2014/mar/03/florida-democratic-party/rick-scott-rick-scott-oversaw-largest-medicare-fra/ https://www.politifact.com/florida/statements/2014/mar/03/fl...

joe_the_user 8y ago
Indeed, The phrase "Robber barons" from 19th century was hardly overstated. America is once again reaching a stage where a large enough fraud and criminality offers an exit strategy into the ruling class.