OIG has a long history of protecting the health and well-being of HHS beneficiaries, including residents in long-term care facilities such as nursing homes, many of whom are seniors. As part of our commitment to this important work, our oversight agency collects and investigates tips and complaints about fraud, waste, and abuse in these facilities.
Unfortunately, during the COVID-19 pandemic, we have seen a spike in the number of reports of elder harm and neglect. Also, of great concern is the rise in the number of bad actors preying on unsuspecting individuals in our country, including many Medicare and Medicaid beneficiaries.
As we continue to aggressively investigate those who cheat our programs or hurt beneficiaries, we want you to know that the public can effectively advocate for this vulnerable population by reporting patient safety and fraud concerns. While there are many ways that long-term care residents can be subject to harm, here are a few:
Harm or Neglect
- If residents have bruises, fractures, lacerations, abrasions, contusions, or other bodily injuries, this may indicate potential physical abuse, sexual abuse, or neglect.
- Behavioral changes or non-verbal signals that a resident may be in fear of specific staff or caretakers. This may indicate possible abuse.
- Poor hygiene and sanitation practices and delays in transferring ill residents to hospitals can result from failures in quality of care.
- Employees who do not follow COVID-19 health and safety precautions demonstrate inadequate infection control measures and risk exposing residents and other staff to the virus.
Fraud
- Fraudsters visit facilities and offer medical services in exchange for Medicare and Medicaid numbers that are then submitted in fraudulent claims to insurers.
- Scammers reach residents via unsolicited telephone calls, television commercials, and internet pop-up ads attempting to obtain personal information and commit medical identity theft.
- Fraudulent health care providers and prescribers may provide medically unnecessary treatments and products to residents and bill for the illegitimate services.
Take the Lead:
Report Fraud, Abuse, and Neglect
If a senior is not in urgent danger, but you suspect fraud, abuse, or neglect has or is occurring, please report your complaint to local law enforcement, state agencies, including your state Medicaid Fraud Control Unit (MFCU), or to HHS OIG at tips.hhs.gov.
In addition, should you, or someone you know, be in urgent life
threatening danger, please call 911 for an immediate response. Medical
authorities can address the issue quickly and alert the proper
authorities that a nursing home may be failing to keep residents safe.
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