Program of All-Inclusive Care for the Elderly (PACE) Fraud
The Program of All-Inclusive Care for the Elderly, also known as PACE, provides services to disabled citizens over the age of 55 that require a level of care similar to that of a nursing home. They provide coverage for a variety of services, including hospital care, in-home care, social work, prescription drugs, and a myriad of others to qualified Medicare and Medicaid beneficiaries.
There are over 120 PACE locations spanning 31 states, of which most are funded primarily by state and federal Medicare and Medicaid programs. Though these facilities are governed by regulations set by the Centers for Medicare & Medicaid Services (CMS), day-to-day operations vary by state and provider – which can often lead to blurred lines in the administration of appropriate care techniques.
Fraud in PACE Examples
Fraud in PACE (sometimes referred to as Living Independence for the Elderly, or LIFE) can mirror aspects of fraud in other verticals of elder care, such as nursing homes, home health, and hospice facilities. Many fraudulent practices in such programs involve violations of the False Claims Act, including:
- Billing for services not rendered or not medically necessary
- Submission of claims at a higher rate than the care that was provided (i.e. upcoding)
- Providing excessive care for the purpose of receiving undue compensation
- Paying kickbacks or bribes for referrals
- Recruiting potential clients by means of offering inappropriate incentives
- Billing before care has been provided
The nature of these practices put both the government healthcare system and our most vulnerable citizens at risk. Because PACE relies on Medicare and Medicaid funding, it is inherently susceptible to fraud. At Whistleblower Justice Network, we believe that protecting the elderly and the integrity of healthcare takes precedence above all. We partner with whistleblowers who prioritize compassion, ethics, and justice – and stand with them every step of the way.
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