July 29, 2014

Elyria
Cloudy
70°F
test

Loophole boosts nursing homes’ income

CLEVELAND — Some Northeast Ohio nursing homes use a Medicare loophole to accept hundreds of mentally ill patients discharged from hospital psychiatric wards, spending millions of taxpayer dollars to house patients who often do not qualify for nursing home care, a state investigation found.

Mentally ill patients are eligible for nursing home care paid for by Medicaid if they need 24-hour supervision or hands-on assistance, but an investigation by the Ohio Department of Mental Health found that 60 percent of the psychiatric patients admitted into Cuyahoga County nursing homes don’t need such intensive care, The Plain Dealer reported.
Medicaid pays about $148 a day to house such patients, about three times what it would cost to care for the patient in a group home.

Many patients stay in the nursing homes for months or years, even after being deemed unqualified by state evaluators and ordered to leave the facilities, the investigation found. The three Cleveland-area nursing homes at the center of the inquiry, all run by Saber Healthcare Group, received $59 million in Medicaid funds from 2005 through August 2007, according to the state.

The state’s Department of Mental Health estimates that about 1,300 psychiatric patients a year are admitted to Ohio nursing homes under a Medicaid rule that allows 30-day convalescent stays. The rule allows patients to get in on a doctor’s signature, bypassing independent, face-to-face admissions reviews. Of these patients, 40 percent are in Cuyahoga County.

The system provides a windfall for nursing homes, at the public’s expense, said William O’Boyle, a licensed clinical counselor who evaluated nursing home patients for the Department of Mental Health.

“The nursing homes serve as a rescue,” O’Boyle said. “It’s not a proper solution. There’s no accountability.”

O’Boyle filed a Medicaid fraud complaint against Saber Healthcare, claiming the company let ineligible patients stay while it continued to draw Medicaid stipends. O’Boyle’s complaint also accused representatives of the company of visiting homeless shelters seeking potential admissions to three of the company’s nursing homes — Cleveland Rehabilitation, University Manor and Rudwick Manor.

The Bedford Heights-based company denies O’Boyle’s allegations, which also claim Saber Healthcare employees visited homeless shelters seeking to boost admissions under the Medicaid provision.

Saber Healthcare does not have to discharge patients until they have secured housing, and the state’s standards for determining eligibility for nursing care favors the elderly, not mentally ill patients who may require months of care, said William Weisberg, part owner of Saber Healthcare.

“The people I see need to be in a controlled environment,” he said. “I see more people who are discharged and fail than who are discharged and stay out.”