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„I do think there’s an oversight issue … There aren’t a lot of safeguards in the system,“ says Ken Moore, a senior assistant attorney general in South Carolina’s Medicaid Fraud Control Unit, which has prosecuted at least a dozen trust fund theft cases in recent years.“A lot of these cases involve an office manager or a business or finance manager, and they’re the only ones at the facility who really know how much money is coming in and going out of these accounts, Moore adds. „So these cases can be very difficult to detect — a lot of these people get caught just by happenstance.“In 2010, Moore’s office convicted a nursing home business manager who was caught forging checks from the trust fund after she dropped one of the checks in the parking lot. A co-worker found it, triggering an investigation into the theft of $50,000 in residents‘ funds. Says Moore: „If she hadn’t dropped that envelope, I’m not sure she ever would have been caught.“

USA TODAY reviewed thousands of pages of nursing home inspection records, court files and prosecution reports to identify cases of resident trust funds being mismanaged or stolen. The newspaper also studied government reports and interviewed dozens of experts to assess the scope and impact of the problem. Among the findings:Since 2010, state and federal inspectors issued more than 1,500 citations to nursing homes for mismanaging trust funds or failing to protect them from theft, according to USA TODAY’s analysis of data from the Centers for Medicare and Medicaid Services, the federal agency that regulates nursing homes. Most „deficiencies“ involved failing to pay interest, inadequate accounting or not giving residents proper access to their money.

Among more than 100 prosecutions of employees who stole money from trust funds at long-term care institutions, the newspaper found, more than 30% involved thefts of tens of thousands of dollars or more. Most of the thefts involved funds for multiple residents so thousands of elderly residents and their families were affected. At least 10 thefts exceeded $100,000. Lax oversight often allows trust fund thieves to operate for months, even years, without detection. While federal regulations require all nursing homes that participate in Medicare and Medicaid to maintain trust fund accounts, the rules do not mandate any sort of regular, independent audits. Some states have imposed such mandates on their own, but many have not. State and federal inspections at nursing homes and other long-term care facilities typically focus on resident health and safety, devoting relatively little attention to the management or security of resident trust funds. USA TODAY surveyed 36 state and local ombudsmen and 32 of them — nearly 90% — said tighter oversight is needed, either through new regulations or better enforcement of existing rules.