August 30, 2014

High Profile Report - Faulty Medicare Rating System?

by Levin & Perconti

Nursing homes and long-term care facilities are among the many health care providers that can submit reimbursements to Medicare and Medicaid, which are federal programs administered through the states, for expenses incurred for treating and caring for patients who are insured by Medicare or Medicaid. These federal program s lay out certain rules that providers must follow in order to maintain eligibility for such reimbursements.

The government also provides reviews and ratings on certain facilities, including disciplinary action taken against them for violating rules. The Centers for Medicare and Medicaid Services (CMS) specifically uses what it calls a “Five-Star Quality Rating System” for its Medicare program to provide information to consumers, including patients and/or their families and caregivers, in doing the due diligence to find the right facility for the best level of care. As the New York Times describes it, it is like a hotel-style rating. Approximately one fifth of the over 15,000 nursing homes across the United States has the top 5-star rating.

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August 28, 2014

Nursing Home Settles False Claims Act Case

by Levin & Perconti

The False Claims Act is a law that allows for the government to sue those who have allegedly defrauded the federal government. These lawsuits can also be filed by individual citizens who believe they have uncovered evidence of fraud against the federal government, and the United States Department of Justice has the option to get involved and prosecute the matter.

Medicare & Medicaid Fraud in Nursing Homes

In the healthcare industry, there are often many examples of fraud in the context of Medicare and Medicaid. Medicare and Medicaid are of course programs administered by both federal and state governments, largely with federal dollars. In exchange for accepting money for either program, states and healthcare providers must follow certain rules and regulations as to how they conduct themselves and do business. If all goes well, those providers can then submit for reimbursement from Medicare and Medicaid. However, many providers unfortunately will overbill these programs in order to get back more money, which is pure and simple a fraud perpetrated on the government. Many states have their own versions of the False Claims Act, and can also be the target of fraudulent activity.

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August 25, 2014

Speaking Up - Whistleblowers Help Avert Healthcare Fraud

by Levin & Perconti

Whistleblowers have played a vital role in weeding out illegal practices in the private sector, abuse of authority, waste, fraud and gross mismanagement in government agencies, and improper activities in international institutions. As we have seen time and time again, whistleblowers have also played a vital role in the healthcare sector, be it in the private sector or the government.

Reporting Illegal and Unethical Conduct

Whistleblowers helped bring to light the scandal at the Veterans Administration, where it was discovered that multiple hospitals and care facilities run by the VA across the country kept patients waiting for visits and treatment for months at a time. Such neglect hastened their illnesses and injuries, and led to untimely deaths for many. To make things worse, the VA furthermore covered up these horrible issues. Whistleblowers have also been valuable in ferreting out fraud when it comes to Medicare and Medicaid programs. Where an individual blows the whistle on fraud under the False Claims Act, he or she can reap a bounty payment for their efforts if the government recovers. This also depends on other circumstances, such as the size of the recovery. As with any false claims case, such false claims stand to defraud the government as well as the taxpayers.

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August 22, 2014

Keeping a Close Eye - The Need to Monitor Breathing Tubes

by Levin & Perconti

Some elderly and incapacitated resident patients of nursing homes and long-term care facilities have to use breathing tubes in order to aid their breathing and the oxygenation of their bodies and brains. Without the proper level of oxygen going to the brain, a person can suffer brain damage and eventually death. Unfortunately, in some sad instances a patient’s breathing tube can become clogged, and the effect is essentially like choking, where the person’s oxygen is depleted and they can lose consciousness, suffer brain damage, and die. If they are saved in time, brain damage could affect them for the rest of their life.

Breathing tubes are used to aid those who are unable to breathe on their own. These tubes in general are plastic tubes inserted into a patient’s throat or nose. Where a breathing tube is needed for a longer term of time, a more involved setup will be used where the tube extends down the patient’s throat, and makes it impossible for them to eat, drink or speak so that they need nutrition and water either intravenously or through a separate feeding tube.

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August 21, 2014

Back to the Basics - Falls in Nursing Homes

by Levin & Perconti

Falls can happen anywhere and anytime to anyone. Yet the common stories we hear most about tend to be when our elderly or otherwise incapacitated loved ones suffer a fall, largely because of any incapacity. Such falls can lead to serious injuries, such as broken or fractured bones, concussions, and even death. There is also an enormous psychological impact, as one fall can leave a person in perpetual fear of falling again, which can in turn lead to self-isolation and even depressive thoughts of helplessness.

In nursing homes, falls are a significant problem, and lead to even bigger problems. According to the Centers for Disease Control (CDC), as of 2012, for every 100 nursing home beds, there are approximately 100 to 200 falls per year, including some who fall more than once. And among the multitude of falls that occur, almost 2,000 people die each year from a fall at a nursing home, and anywhere from 10%-20% of falls at nursing homes can cause serious injuries, while 2%-6% result in bone fractures. Interestingly, 35% of falls occur with nursing home residents who are unable to walk, which may call into question the lack of supervision of those people by nursing home staff. According to the CDC, some of the many causes of falls in nursing homes include:

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August 19, 2014

Psychiatrist Suspended and Sued for Dangerous Use of Medications

by Levin & Perconti

One of the major issues we recently wrote about in the context of nursing homes and elder care has been the use of chemical restraints on residents. A problem has been the misuse and overuse of these medications, as well as the oscillating back and forth between different types of medications, including ones that were never even prescribed.

In a recent case, a psychiatrist’s license has been suspended indefinitely by the Illinois Medical Board for his prescribing a certain antipsychotic medication to his patients. Dr. Michael J. Reinstein used the antipsychotic drug called clozapine on what the Chicago Tribune reports as more than 50% of his patients at nursing homes and mental health facilities. This drug is “known as a risky drug of last resort,” and was associated with the deaths of three patients under Reinstein’s case. The drug has also reportedly been at the center of shady kickback deals between the drug’s maker and doctors, and Dr. Reinstein’s case is no different. Dr. Reinstein has been accused of using the drug in exchange for $350,000 in bribes from the drug’s manufacturer, Teva Pharmaceuticals, over the course of seven years, in spite of the fact that he could employ other medications or treatment methods for his patients, and in spite of the danger the drug poses to the health, well-being, and ultimately lives of patients. Reinstein also allegedly received other gifts from the company, including free travel, a fishing trip, boat cruise, and dinners, as well as sporting event tickets. This indefinite license suspension by the medical board was the culmination of a years-long investigation by the Chicago Tribune and ProPublica.

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August 16, 2014

Illinois Statute Aims to Decrease Elder Abuse

by Levin & Perconti

The state of Illinois takes elder abuse very seriously. This is evident from the state legislation that defines the problem and mandates the response of specific agents within the jurisdiction. The Elder Abuse and Neglect Act was implemented in 1988 based on concerns for the safety of older residents. The initiative defines elder abuse as follows:

*Physically striking or battering an elder
*Sexual abuse, including touching, fondling or sexual intercourse with an elderly party who is unable to provide informed consent, or is threatened or forced to consent
*Emotionally abusing an elder through threats of abuse or intimidation
*Confinement of an elderly person through restraint or isolation
*Passive neglect or the failure to provide for an elder's basic needs
*Failure to protect an elder from harm

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August 12, 2014

IL Nursing Home Issue - Chemical Restraints Are Still Pervasive

by Levin & Perconti

"Chemical restraints" are the use of drugs in order to restrain, or subdue, nursing home residents and patients. Drugs can be prescribed by doctors as a means to keep patients subdued or calm where they would otherwise be prone to physical and even violent outbursts in behavior. Patients with dementia or some type of psychosis, for example, can experience these episodes, and pose a safety issue to others around them, and of course themselves. These medications are often referred to as antipsychotic medications. In many instances, however, patients do not truly need these antipsychotic drugs, or do not need nearly the amount that they are given by nursing home staff. Sometimes staff will use antipsychotic medications to subdue patients who were not even prescribed the medication. This is where prescribed or non-prescribed drugs all of the sudden become a form of chemical restraint. Nursing home staff may simply use these chemicals improperly to make their own jobs easier so they keep patients subdued, and pharmaceutical companies certainly must not mind the continuing business.

AARP Study

A recent AARP article has highlighted the use of chemical restraints through antipsychotic drugs. It discusses the example of a woman who, after less than three weeks at a nursing home for treatment and recovery from a broken pelvis, and left “withdrawn, slumped . . . chewing on her hand, her speech garbled.”

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August 9, 2014

Reminder - The Risk of Bed Rails in a Nursing Home

by Levin & Perconti

So many awful things can happen when patients and residents, be they elderly or otherwise debilitated, are not attended to properly at nursing homes or long-term care facilities. Residents of nursing homes can be vulnerable to wandering, elopement, as well as dangerous falls. Certain accidents can happen even when residents are not even on their feet, though. Many of these are with bed rails, in which the patient can become caught, injured, or even strangled. According to the Food and Drug Administration, these accidents occur in nursing homes as well as hospitals. From 1985 through 2008, 803 patients have reportedly been “caught, trapped, entangled, or strangled in beds with rails” and 480 of these people have died as a result, with over 100 suffering injuries. While bed rails can help keep patients from falling out, they also pose risks.

Bed rails have posed a serious risk to patients at hospitals, nursing homes and anywhere else they are used for decades. In nursing homes in particular, they are particularly risky because the elderly and infirmed are particularly vulnerable to becoming stuck, injured, or even dying as a result of getting their heads caught and suffering asphyxiation. It is not just risky for the physically challenged, but also for those who perhaps suffer from dementia or Alzheimer’s Disease. Earlier this year, for example, an elderly woman became caught in her bed rails, and staff eventually found her dead. While the use of bed rails has reportedly gone down over the years, they are still used enough to cause concern. Of course, and as stated, they may have benefits in terms of securing patients in their beds, but if used bed rails must be inspected and aligned carefully to prevent patients from becoming injured.

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August 5, 2014

Back to the Basics - Malnutrition and Dehydration in Nursing Homes

by Levin & Perconti

In thinking about elder abuse or general patient abuse at nursing homes and long-term care facilities, it may be most obvious that affirmative acts, such as physical abuse, chemical abuse in the form of unnecessary overmedication, and sexual abuse. However, sometimes it’s the failure to act that can also jeopardize the health, well-being and lives of patients and residents of these homes. Sadly, among the omissions and failures to act are the serious problems of malnutrition and dehydration that occurs as a result of neglect of the care of the elderly and otherwise disabled members of our population.

The Consequences

Unfortunately, it is more common than one can fathom for residents of homes to lack the proper amount of food and water. In particular with food, malnourishment can occur from eating anything devoid of nutrients, not eating enough, or eating nothing at all if a staffer were to cruelly withhold food or water from a resident. This can all result in serious weight loss, which on its own is dangerous enough, but can also compound other problems where the body needs to be stronger to fight other ailments.

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August 1, 2014

Medicaid Backlog Continues to Plague Illinois Residents

by Levin & Perconti

When it comes to health care across the country, the term “back log” has been an unfortunately common part of our lexicon. Backlogs have been famous for years with the U.S. Department of Veterans Affairs, for example, as news throughout this year has revealed serious fraud in the cover-ups of these backlogs by management at VA health care facilities. Other medical facilities and health care providers experience backlogs, and this has unfortunately happened in assessing eligibility of Illinois residents for Medicaid, including those in need of nursing home care.

In the last year or so, the state of Illinois created and has implemented a new system in order to make the process of determining eligibility for state residents who seek state-funded care at nursing homes. The state has hired more employees in order to accomplish this. However, as recently reported in the Chicago Tribune, the NWI Times and multiple other news outlets, an audit report of the situation detailed that as of July 1, 2014, more than 51% of submitted cases for consideration were not resolved within 90 days. Federal regulations mandate a turnaround time of 45 days. Out of 4,226 pending applications, 2,141 languished past the 90 day mark. An additional source of delay has been the federal government’s slow pace of transferring applications to the state.

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July 30, 2014

Mistrial Declared in Illinois Nursing Home Sexual Assault Case

by Levin & Perconti

The types and severity of nursing home abuse, neglect and exploitation are wide and varied, but the one thing anyone can agree on is that any such type of behavior is unacceptable, improper, inhumane, and illegal. These illegalities and improprieties are governed in part through civil and regulatory laws and enforcement. States and the federal government pass laws, rules and regulations that force nursing homes and long-term care facilities, among other healthcare providers, to operate with certain standards in caring for their patients and residents, who in many cases are elderly. On top of civil enforcement, acts of elder abuse or nursing home abuse and neglect are governed by our criminal laws as well. Nursing home staffers committing such acts can face serious criminal charges for their conduct. This can include heinous acts of physical abuse as well as sexual abuse and exploitation.

Illinois Sexual Assault Case

In a recent case in Illinois, a certified nursing assistant at the Crystal Pines Rehabilitation and Health Care Center was charged criminally with sexually assaulting a 92 year old female resident. We had actually reported on this issue in this blog space back in late 2011 after the accusations came to light. According to the record, the alleged victim suffered from dementia and as the Chicago Tribune reported, “was completely dependent on staff.” Without commenting directly on this case itself, it bears mentioning that while the elderly or those in need of care at a facility are typically more vulnerable, those with mental ailments like dementia are very much a vulnerable group. This affliction also fueled the accused’s defense attorney’s defense theory that the alleged victim was simply psychotic and deluded into thinking people were out to harm her. Doctors were unable to locate signs of trauma in examining her as well. Furthermore, the defense has relied on an argument that the defendant nursing assistant was “coerced” into “signing a false confession after a lengthy interrogation” by police.

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