Adult Care Home and Assisted Living Facility Fraud and Abuse

Assisted Living FacilityMost operators of assisted living facilities and ‘Adult Care Homes’ are honest professionals who work hard providing high quality care for their residents. They often face difficulties in finding qualified help, dealing with the bureaucracies of government and private insurance companies and observing the many laws and official guidelines that necessarily regulate this industry. Unfortunately, adult care and assisted living facilities are not immune to occasional cases of neglect, incompetence, or outright fraud.

Finding Assisted Living and FindingAssistedLiving.com exist to look out for the interests of seniors, their families and loved ones. This sometimes includes making you aware of the “bad apples” in this business.  Incompetence, neglect, unacceptable standards and even criminal fraud are sometimes found in the adult care industry. When they are, FAL will do our best to bring it to your attention. When making any decision about senior life transitions, you need to know about the bad providers as well as those who are good and outstanding.

Take the case of Sylotte Pierre who operated a small Adult Care Home in the town of Lehigh Acres, a Florida community just inland from Ft. Myers on Florida’s west coast. An Adult Care Home is defined as a “custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.” This is an important responsibility, a necessity for seniors and their loved ones.

Unfortunately, according to the Florida Agency for Health Care Administration (AHCA), Ms. Pierre was grossly negligent in living up to this responsibility. According to the AHCA, this operator left the facility unattended by qualified caretakers for a full week before this was discovered by an Agency investigator. She had employed several individuals who had no professional training and who had not undergone the criminal background clearance required by law for all workers in Adult Care Homes.

In addition, there were other violations that endangered residents of this small facility. The four person licensed capacity of the care home had been exceeded and the designated relief person was absent when the AHCA investigator arrived. These conditions led the Agency to order an immediate ‘Emergency License Suspension’ order effective August 1, 2016.

Florida residents, especially seniors, are fortunate to have a watchdog agency like AHCA looking out for the welfare of assisted living and care home residents. Finding Assisted Living and FindingAssistedLiving.com are happy to help by bringing this situation to your attention. Bringing you unbiased, factual and knowledgeable advice and help is a big part of FAL’s reason to exist.

As bad as this example is, a worse situation had come to light a week before in South Florida. Ms. Pierre’s case is an example of neglect and dereliction of duty on the part of a single individual operating a small Adult Care Home.  In contrast, the instance in Miami is a case of criminal fraud committed by a huge corporation and its operating officers.  Nothing like Ms. Pierre, these people were very astute business operators who willfully defrauded the Medicare system of over a billion dollars! That’s “B” as in billion. For these people, stealing a million dollars would have been petty theft!

Gavel and US flagIn a United States Department of Justice indictment, the three people initially charged, operated a network of over 30 clinics, skilled nursing homes and assisted living facilities giving them access to thousands of Medicare and Medicaid beneficiaries and their medical records. These unsuspecting victims were then admitted to a facility in this network where they received medically unnecessary services that were billed to Medicare and Medicaid. Afterward, they were referred to other health care providers, including community mental health centers and home health care providers who paid kickbacks to the conspirators. See the story here: Three individuals charged $1 billion medicare fraud and money laundering scheme

This single case cost the Medicare system and the American taxpayers who support it over a billion dollars! This is what U.S. Attorney Wifredo A. Ferrer said about this matter-

“Medicare fraud has infected every facet of our health care system. As a result of our unrelenting efforts to combat these pernicious schemes, the Criminal Division, the U.S. Attorney’s Office and our law enforcement partners continue to identify and prosecute the criminals who, driven by greed, steal from a program meant for our aged and infirmed to increase their personal wealth.”

Since 2007, the Justice Department’s Medicare Fraud Strike Force has charged nearly 2,900 defendants who have collectively billed the Medicare program for more than $10 billion. This is money meant to help deserving seniors pay for much needed medical and extended care services. It is your money and Finding Assisted Living wants to keep you informed. Visit the FindingAssistedLiving.com website often for up-to-date information about this and other important matters affecting senior care.

Finding Assisted Living and FindingAssistedLiving.com strive to be your source of knowledgeable, unbiased information about all aspects of senior life issues. Through our system of vetted and approved vendors, professionals in many fields and FAL’s Senior Transition Pro Team, we seek to provide seniors and their loved ones with accurate information about all facets of senior living. One of the core concerns of Finding Assisted Living and FindingAssistedLiving.com is the field of assisted living facilities and adult care homes. If you, a family member or loved one are dealing with this issue, please seek us out at FindingAssistedLiving.com. We will always seek to place the interests of the senior resident, patient or client first!

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