September 21, 2014

Should There Be Cameras in Nursing Homes?

by Levin & Perconti

In the context of abuse and neglect at nursing homes and long-term care facilities, there has been the pressing question of whether or not these facilities should be required to keep cameras in order to monitor the conduct of staff at the facilities. In fact we have written previously in this blog about that issue. Many proponents of such cameras have seen it as a tool to capture illegal or wanton behavior, or to find out if patients are truly not getting the proper care and attention they need. Cameras also pose to act as a deterrent to those who might otherwise consider acting inappropriately, and could also motivate staffers to be more attentive to patients, knowing full well that a failure to visit a patient to check in on them, or to administer timely medication, will be evidenced on camera when staffers fail to make their way to that patient’s room for far too long a time.

The controversy over using or not using cameras in nursing homes continues to brew after news out of Oklahoma City, Oklahoma, where a staffer at a nursing home was sentenced to a 10-year suspended sentence, four years of which she must serve in custody, after she was found guilty of physically abusing an elderly patient at the nursing home where she works and the patient resides. The victim’s family had themselves put a video camera in their mother’s room at the facility in order to figure out why she had suffered from bruising on her arms and face, as well as after she exhibited perpetual fear at the facility.

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September 17, 2014

Case of Nursing Home Sexual Abuse is a Wake-Up Call

by Levin & Perconti

In discussing abuse and neglect at nursing homes and long-term care facilities, we often tend to focus on the general concepts of physical abuse, verbal abuse or emotional abuse. These are all unfortunately very common forms of abuse by facility staffers perpetrated upon its residents who seek only care and compassion as they struggle through ailments, injuries and generally physical and mental challenges. One area of abuse that can sometimes be overlooked is that of sexual abuse, which people may not realize does happen at nursing homes and facilities. Nurses, aides and other staff have practically unfettered access to patient residents at their facilities, and unfortunately take advantage of that access, and a patient’s vulnerabilities, to satisfy their own sickening needs.

Over the summer, there was a case in Brunswick, Maine in which it was discovered how an elderly man was sexually abused by staff at his nursing home back in 2006. The victim had dementia, and was legally blind and partially deaf as well. Dementia is not uncommon for those entering into the care of a nursing facility, and this combined with his loss of sight and difficulty hearing led him to be particularly vulnerable to the preying of others. At the age of 89 years old, as Portland, Maine media recounted, the man made attempts to tell his family how a staffer at the nursing home would sexually abuse him. It was at first thought to be simply mistaken words from a man who was simply confused and suffering from mental ailments. Yet months later, another employee caught the guilty staffer in the act of exploiting the victim for sexual favors.

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September 14, 2014

Omnicare Sues Nursing Homes

by Levin & Perconti

The pharmaceutical company Omnicare is a company largely in the news as it relates to accusations and allegations of fraud against taxpayers by the nursing homes and long-term care facilities with which it does business. These has stemmed largely out of claims under the False Claims Act, which allows the government to recoup money and penalties from a person or entity that takes federal dollars on the basis of fraud. In the healthcare sector this is an unfortunately common scenario, and typically occurs through fraudulent billing by health care providers for reimbursement through Medicare and Medicaid for services not rendered or provided, or not adequately provided. We have observed before how Omnicare has faced claims of bribery of health care providers to steer business its way which would ultimately be paid for largely through these federal programs. In the last year or so it has already settled with the Justice Department in one case. Now, Omnicare finds itself on the other side of the coin, this time as it sues another nursing home operating for more than $28 million.

New Nursing Home Company Lawsuit

Omnicare Inc. recently filed suit in Illinois against nursing home facilities owned and operated by Eric A. Rothner for failing to pay for purchase contracts. These purchase contracts apparently include Omnicare’s supply of medications, supplies and other nursing home-related services for the relevant facilities, some of which Mr. Rothner has asserted he no longer controls. The company, however, has argued that rather than no longer failing under his ownership or control, some of these facilities simply have changed ownership to other entities owned by Mr. Rothner in an attempt to avoid paying outstanding debts they owe to Omnicare.

Omnicare maintains that the debts accrued when the entities for under his control, and that merely moving control of them did not change the fact that they owe Omnicare on the purchase contracts. Omnicare has reportedly gone after this debt for nearly a decade, having filed suits against more than four dozen nursing home facilities across Illinois, Indiana and Ohio. In 2011, Mr. Rothner and the nursing facilities he owns had agreed to pay $125,000 per week to maintain those purchase contracts while the two sides tried to work out a resolution to the dispute. According to a Law360 article, those weekly payments decreased without agreement. The $28 million sought by Omnicare include the costs of goods and services as well as overdue payment penalties and financing charges. Omnicare, which itself has faced accusations of fraud in the past, has also accused the nursing homes in question of reporting drug and supply costs to Medicaid that they did not actually incur. Reporting false costs to the government for reimbursement through Medicare or Medicaid is a fraudulent act subject to the False Claims Act.

It remains to be seen how this litigation will play out. Besides the deep questions of breach of contract and unjust enrichment, this case demonstrates the tangled web of business in the health care industry. Some of the accusations involved directly implicate the lawful functioning of nursing homes, which can be of concern to citizens and the nursing home consumers themselves.

See Related Blog Posts:

Speaking Up – Whistleblowers Help Avert Healthcare Fraud

Nursing Home Settles False Claims Act Case

September 12, 2014

Weight Loss Surgery May Reduce Chances of Alzheimer’s

by Levin & Perconti

Many residents of nursing homes and long-term care facilities suffer from psychological illnesses, such as Alzheimer's and other types of dementia. For these patients, they are supposed to receive a tailored care plan that doctors, nurses and nursing aides help administer to and monitor for their resident patients.

Scientific and medical research continues to search for more definitive answers as to the sources of Alzheimer’s, as it is still unclear just how some people lose their mental capacity later in life, while others do not. Those with Alzheimer’s experience related dementia as well, although dementia can be caused by a host of events, such as a stroke or tumor. As research into Alzheimer’s continues, scientists also seek answers as to how it might be avoided. Research has already shown a correlation between obesity and the risk of Alzheimer’s, as reports note obese individuals are 35% more likely to develop Alzheimer’s than those of average weight.

New Findings

As a British media outlet, the Telegraph, reported recently, weight loss surgery may actually reduce the risk of Alzheimer’s. According to the study, obese women who went through weight loss surgery, called gastric bypass (which involves bariatric surgery), experienced a reversal of characteristics in a certain part of the brain called the posterior cingulate gyrus which is believed to be linked to the development of Alzheimer’s. Simply put, the posterior cingulate gyrus showed decreased activity in that part of the brain approximately six months after the surgery. Apparently obese women prior to the surgery metabolized sugar faster in the relevant area of the brain than women of average weight. Such brain activity was similar to the brain activity of women leaner women. And not only did activity levels in the part of the brain associated with Alzheimer’s decrease, but certain cognitive abilities were even improved, as this article and another from the UK’s Daily Mail also notes better organizational skills and strategizing skills being two such observations in surgery participants months later.

Other aspects of cognitive thinking as well as memory did not show similar improvement, but the findings on organizational skills and the reduction in activity in the Alzheimer’s-linked part of the brain are enough to catch scientists’ attention. Furthermore, the studies were limited in that it examined only 17 women in their 40s, and the subjects were very severely obese, thus it is still unclear how it might affect people of differing levels of obesity such as those who would not qualify or need gastric bypass surgery.

While the limitations of this study obviously merit further review, it is nevertheless an intriguing observation about the correlation between obesity and the propensity for Alzheimer’s or dementia later in life. We have all heard the maxims about the benefits of eating well, exercising sufficiently and overall keeping our weight down as a part of our overall health. These particular findings present yet another reason to do so. As further research and observation is done in this area, we may learn even more about what older folks can do to minimize chances of Alzheimer’s before it becomes too late.

See Other Blog Posts:

Back to the Basics – Falls in Nursing Homes

New Example of the Importance of Evaluating a Nursing Homes

September 11, 2014

Movement to Reduce Use of Antipsychotic Medications Slow to Take Hold

by Levin & Perconti

As we have previously discussed, the use of antipsychotic drugs on resident patients of nursing homes and long-term care facilities has been a controversial issue for years and years. Antipsychotic medications historically have been used to sedate patients with violent behavior as a result of psychological problems. Patients with schizophrenia, Alzheimer’s or dementia are often the victims of chemical restraints, including those who sometimes exhibit violent behavior that can endanger themselves and others. Thus antipsychotic medications have been used to control them.

However, there have been far too many cases over the years of nurses or nursing aides at nursing homes overusing or misusing medications. In some cases they were overused for patients that may have been prescribed the medications, but did not need nearly the amount given to them. In other situations patients that were not even prescribed the medications were given them anyway in an effort to simply keep most or all patients sedated even if they were not violent. Furthermore, there have been cases of a constant back-and-forth of giving patients sedating medications and then subsequently balancing them out with medications that counteract the sedation to wake the patients up. This constant provision of drugs would cause damage to the minds and bodies of patients, sometimes causing or hastening their deaths. Such abuse has been the subject of state inquiries, criminal charges against nursing home staff, and civil litigation by victims or their loved ones for the damage caused.

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September 7, 2014

Healing & Comfort - Understanding the HOSPICE Act

by Levin & Perconti

These days in Washington, DC., the word “bipartisan” is one that does not get tossed around much. Political strife is pervasive as Republicans, Democrats and anyone else have routinely failed to compromise on a whole host of issues ranging from economic policy to immigration to practically anything under the sun. However, in a recent rare event of bipartisan compromise, the United State Congress has put forth legislation that would increase the watchdog effort specifically over hospice facilities across the country.

The legislation’s aim is to improve transparency and accountability for these facilities, and consequently improve quality of care. According to a Forbes article covering the legislation, which is backed by both House Republicans and House Democrats, the new law is also supported by the hospice care industry. Hospices so far have been subject to government recertification every six to eight years. The new legislation, the “Hospice Act,” now upgrades that process to every three years and calls for more frequent and consistent hospice surveys, while setting aside $25 million to fund these new efforts. If passed, it would ensure greater consistency of visits and thus more eyes on the performances of hospices. The bill was introduced August 1st and is known as H.R. 5393.

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September 4, 2014

New Laws to Improve Nursing Home Care Complaint Filing

by Levin & Perconti

Just recently, Illinois Governor Pat Quinn signed a few bills that affect those in nursing homes and long-term care facilities. One of these bills is intended to better facilitate the complaint process for those seeking to file complaints against nursing homes in Illinois. The Illinois Department of Public Health specifically enforces laws, rules and regulations as they concern nursing homes and long-term care facilities.

The department arranges routine inspections of nursing homes, and gathers data on items like the quality of care of patients, the number of staff, the training of staff, and much more. In addition, the department accepts complaints from residents and their families regarding specific incidents of abuse or neglect, or just general patterns of a failure to properly care for residents. The department will hand down punishments in terms of fines and penalties, probation, and sometimes even suspension or complete closure, depending on the nature of a facility’s offense or offenses, and how long they have gone on without remedy. The department also publishes information on these inspections and enforcement actions in quarterly reports for all to see.

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September 1, 2014

Federal Bill Would Provide for Round-the-Clock Nurses

by Levin & Perconti

The United States government can pass and enforce laws and promulgate rules and regulations pertaining to all types of healthcare where federal dollars or other grounds for jurisdiction exist. This includes in nursing homes and long-term care facilities. Commonly healthcare providers that take federal dollars through programs like Medicare and Medicaid will be obligated to follow federal rules in order to be eligible for reimbursements for care and treatment they give to patients and residents insured by these federal programs.

As the New York Times recounted recently, in 1987 the U.S. Congress considered a proposed bill that would have required all nursing homes to have a registered nurse on the facility premises for eight hours per day. This requirement was irrespective of how big the facility was or how many patients there were. Unfortunately has many know, bills pass through Congress after numerous compromises, and regulations allowing for reduced staff sizes at nursing homes was one of those compromises. Thus in an environment where any conceivable type of emergency could occur, a registered nurse would be around only for one third of the day, with lesser trained staff around the rest of those 24 hours.

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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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