The nursing home chain Brookdale Senior Living has more than 700 facilities nationwide, including five here in San Antonio. Unfortunately, there is now a lawsuit in the California Superior Court by the state’s Attorney General, Xavier Becerra, and other prosecutors who allege that the nursing home chain manipulated Medicare-Medicaid’s rating system by misreporting the hours of nurses and other staff. The lawsuit is one of the first of its kind.
Gaming the system
Misreporting the hours of staff is at the heart of the allegations. The star-rating employed Medicare assigns a star rating system ranging from one (worst) to five (best) to 15,000 eldercare facilities nationwide.
There are in-person examinations by state health inspectors, but the ratings are partially based on self-reporting data, including the amount of time nurses spend with residents. There were 15 metrics in all, including the levels of illness and use of medication, which are both culled from resident’s medical charts. Nevertheless, there was evidence that there was widespread abuse of the self-reporting element in order to raise facilities’ ratings on the Medicare.gov website. By doing so, the fraudulently high ratings would attract new customers, which can be the difference between profitability and insolvency.
A money-making proposition
This misreporting of data was not a company-wide policy. Still, some administrators engaged in fraudulent behavior to get more patients and attract those who were financially stable enough to pay their bills. According to the New York Times:
- Five-star facilities earned $2,000 in profit per bed,
- Three and four-star facilities earned $1,000 per bed.
- One and two-star facilities were usually not profitable.
In 2018, Medicare board members brought the issue to the administration, which began to audit the data submitted.
Holding these businesses accountable
The pandemic has been particularly hard on elder care communities, including both residents and staff. But this lawsuit in California is one more reason why it is essential to continually monitor the level of care received by a loved one. It helps ensure that the residents get the care they need. If the facility is acting fraudulent, the victims can follow the Attorney General’s lead and file a lawsuit.