The Monroe County Board said this week a lengthy investigation uncovered that the county-owned Oak Hill senior care facility received excess Medicare payments over several years – citing this matter as a factor in the recent decision to transfer operations late last year to Accolade Healthcare.

The Medicare billing irregularities at Oak Hill were found as part of a three-year investigation initiated in February 2023 following a “whistleblower” report submitted to then Monroe County Board Chairman Dennis Knobloch and State’s Attorney Ryan Webb, the commissioners stated in a press release posted Thursday night on the county government website.

“An internal review into the whistleblower allegations quickly revealed evidence of significant problems, prompting the county board to order a seven-year forensic audit of medical billing records,” this press release states.

The audit was conducted by Armanino LLP, an outside auditor specializing in long-­term care billing issues. Oak Hill records from 2016 through 2022 were examined, with the total cost of the audit being $265,624.09.

The commissioners said this audit revealed a “pattern of severe billing irregularities” – including an Oak Hill billing employee improperly moving hundreds of thousands of dollars in excess Medicare payments between resident accounts; unusual and unexpected billing and payment entries in the billing software to allow for excess payments to be moved between resident accounts; inaccurate quarterly reports filed with Medicare falsely stating that no excess payments had been received by Oak Hill; and several “blank record” entries in the billing software that had no supporting documentation.

The press release added that county commissioners also ordered a review of other internal operations at Oak Hill, which uncovered what it labeled as “serious compliance issues.”

“Following the discovery of these issues, auditors, consultants and attorneys assisting Monroe County unanimously recommended that the county cease management of the facility,” the press release states.

This decision was primarily driven by what the commissioners said where “financial realities” such as increased expenses due to Medicare-required controls and oversight; mandatory compliance costs that would worsen Oak Hill’s financial condition; and increased operating costs that would ultimately be shouldered by county taxpayers through increased real estate taxes.

“Out of concern of losing Medicare funding and to ensure the long-term viability of Oak Hill for the next generation, the Monroe County Board of Commissioners made the decision that it was time for the county to exit the nursing home business,” the press release states. “After an exhaustive search for a new operator in the spring and summer of 2025, the commissioners decided to transfer Oak Hill operations to Accolade Healthcare.”

This transfer of operations and reimbursement of excess Medicare payments is a condition of the county’s offer to settle the Medicare billing issue, the press release detailed. On the agenda for Tuesday’s county board meeting is a resolution approving a payment regarding Medicare overpayment.

The commissioners said they plan to forward documentation related to this investigation to the U.S. Attorney’s Office.

The county also plans findings of the audit once Medicaid officials confirm receipt of the county’s self-disclosure filing, although commissioners have yet to release information about the decision-making process in selecting Accolade as the lessee of Oak Hill.

The Illinois Health Facilities and Services Review Board included that requirement in a “permit approval letter” to commissioners dated Nov. 25, following the board issuing a “certificate of need” required for Accolade’s takeover of Oak Hill.

As part of the permit being issued, commissioners must “provide all available documentation regarding the process of selecting viable candidates to lease and/or operate Oak Hill.” 

Those documents include anything that describes “the ultimate decision-making process leading to the selection of Accolade Ventures LLC, including, without limitation, (Monroe) County Board meeting minutes, public notices, requests for proposals (RFPs), memorandums, communications to candidates, residents and community members, etc.”

The decision to pursue a lease-to-purchase arrangement with Accolade was announced in August, with commissioners approving the tentative agreement during a special meeting Aug. 26.

During that meeting, the suspected Medicare billing issues and subsequent forensic audit were briefly presented as part of the decision by commissioners to explore the possibility of divesting the county from its interest in the skilled medical care industry.

A first five-year lease term outlined during that meeting went into effect Dec. 1.

The decision was met by backlash from county residents who spoke during the special meeting and several subsequent hearings.

Many speakers noted a lack of transparency on the part of county officials in addition to concerns regarding a potential for lower quality care at Oak Hill once it came under the stewardship of a private, for-profit business.

The HFSRB had its own questions about transparency, as noted in a recently-published letter on the review board website dated Oct. 27.

In response to a question as to how “the new operator and county board (will) ensure transparency and ongoing public input during the transition,” an attorney representing Monroe County and Accolade Healthcare responded by suggesting “claims regarding the lack of transparency surrounding the change of control are unfounded.”

The attorney then explained that Monroe County’s “labor attorney contacted the union business agent on Oct. 4, 2025, to provide advance notice of the pending lease agreement” even though the proposal was first announced in early August.

The attorney also argued the “public were provided an opportunity to provide comments on the proposed transaction” during the the Aug. 26 meeting even though the lease details were mostly hashed out prior to that meeting without any prior public input.

The idea to lease Oak Hill and efforts to find a suitable lessee began that spring – several months prior to the public being made aware of the plans.

The announcement comes with a little over a month until the general primary election March 17.

Current Monroe County Board Chairman George Green is facing competition for his seat from Marvin Wittenauer in the Republican primary.

One of Wittenauer’s platforms is the county’s handling of the Oak Hill lease. Green joined the board in 2020.

During a candidate forum prior to the 2021 election, Green addressed “rumors” of Oak Hill being sold.

“My position is, before that would ever happen, that is something that would have to be discussed with the citizens, and I would suggest it would have to be a referendum,” Green said.

Per the lease agreement with Accolade, if both parties agree to a second five-year lease, a referendum question would be put on a ballot in 2030 or 2032 asking voters if Monroe County should sell the business and property associated with Oak Hill.