Techniques for Investigation of Nursing Homes, Adult Boarding Homes, and Medicaid Providers (From Criminal and Civil Investigation Handbook, P 6-31 to 6-47, 1981, Joseph J Grau and Ben Jacobson, ed. - See NCJ-84274)

• NCJ Number: 84310
• Author(s): H J Hoffman
• Date Published: 1981
• Length: 17 pages
• Sale Source: McGraw-Hill Publishing Co
• Language: English
• Country: United States of America
• Note: *This document is currently unavailable from NCJRS.

Annotation

Techniques are discussed for investigating fraud and patient abuse in nursing homes, the investigation of adult boarding homes which house Supplementary Security Income (SSI) recipients, and the investigation of Medicaid providers who treat SSI recipients and others on welfare.

Abstract

The discussion of the investigations of nursing homes outlines the general steps in fraud investigations, including descriptions of types of Medicaid fraud, how to detect fraud, and the investigator's role in fraud detection. How to conduct a patient-abuse investigation and the use of expert witnesses are also considered. Typical crimes in adult boarding homes are noted to include the theft and forgery of checks arriving for departed residents and failure to make refunds to departing residents who have overpaid the rent. The investigative steps described give particular emphasis to the use of computer printouts and audit steps. The investigation of resident abuse in boarding homes is briefly discussed. Examples of fraud by Medicaid providers precedes a discussion of the investigative steps commonly used. Attention is given to the investigative use of the Medicaid Management Information System and the examination of invoices. A brief comment is provided on crimes involving pharmacies and laboratories.