The nursing home industry has lied to the public, and more importantly, to state and federal law makers for decades to secure more Medicare/Medicaid money. The industry claims to be on the verge of bankruptcy, having no assets to settle litigation settlements and judgments, and demanding more taxpayer money to account for the alleged operating losses nursing homes report.

This lecture will reveal the truth behind the lie- that nursing homes are highly profitable and that operators intentionally understaff to increase their profitability. We will show attendees where and how nursing homes hide their assets to protect them from litigation. This information will maximize the value of your nursing home case at mediation or trial.

• A. Understanding the scam
• a. RUGs (Resource Utilization Guide) & PDPM (Patient Driven Payment Model)
• i. Nursing homes set the acuity level of the patient, which sets the daily reimbursement from Medicare / Medicaid.
• b. Payroll Based Journal
• i. The facilities are required to report their daily staffing in a very detailed manner to the federal government.
• c. Understaffing is at the heart of the scam.

• B. Laundering the money
• a. Cost Reports – annual financial reports required by Medicare/Medicaid agencies.
• i. Census Breakdown
• 1. How to determine the average number of residents in the facility.
• ii. Revenue (Billing)
• 1. The amount of money the facility is reporting as gross and net revenue.
• iii. Expenses
• 1. The amount of money the facility is reporting as expenses, which is highly manipulated and part of the billion-dollar scam.
• iv. Related Party Transactions
• 1. The heart of the money laundering operation. Making the facility look bankrupt when it’s actually highly profitable.
• v. Net Income
• 1. The amount of profit/loss that is reported by the facility and is the end result of the money laundering operation.
• vi. Balance Sheet
• 1. The assets and liabilities of the facility. Manipulated by the use of related parties.
• vii. Staffing
• 1. The heart of the scam.
• 2. Valuing the understaffing in $$.