May 21, 2015

Workers Take Action over Budgets and Staffing Levels

by Levin & Perconti

Update on Planned Nursing Home Strike

In fairly recent news, and as we had discussed previously in this blog space, about 3,500 nursing home staffers in Connecticut voted to go on strike to protest their wages, which in some places were not too far above the state’s minimum wage level. The workers set to go on strike hoped to push the state to re-think its budgeting when it comes to Medicaid funding. A proposed budget would have kept the level of Medicaid dollars going to nursing home as flat, rather than increasing the funding as tied to increasing costs.

Nursing homes could potentially be exempt from other Medicaid cuts under the governor’s proposal, but the lack of funding increase would still have an impact. Medicaid comprises a substantial revenue stream for nursing homes and thus salaries and wages for nursing home employees, would reduce money available to pay those workers and could possibly force some to accept stagnant wages, reduced hours, or even lose their jobs. The strike was set to go into effect on April 24th, though the workers through their union agreed to delay the work stoppage upon a request from the governor while he and legislators continue to work out a resolution on the budget. A strike would otherwise reportedly affect 27 nursing homes across the state, spanning 20 different neighborhoods, leaving those facilities with even fewer staffers to tend to residents, and having to look into temporary replacements.

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May 19, 2015

Poor Nursing Home Care May Have Cost Medicare up to $2.8 million in 2011

by Levin & Perconti

It is no secret that government insurance programs like Medicare and Medicaid, which are meant for the elderly and the poor, respectively, serve as chief revenue sources for nursing homes and long-term care facilities. Thus it is vital for facilities to meet certain regulations and levels of care under federal and state laws so that they can remain eligible to earn Medicare and Medicaid reimbursements for those insured residents. Unfortunately, this strong revenue stream can be abused, as when medical providers such as nursing homes overbill, bill for unnecessary treatments, or bill for treatments that never actually occurred, all to charge the government, and thus us taxpayers, more.

As examined in a New York Times article in mid-April, the Office of Inspector General of the United States Department of Health and Human Services, which has the overall authority over federal health matters including Medicare and Medicaid, released a report last year that showed a tremendous amount of spending on nursing homes through Medicare while far too many residents were actually injured from the medical care. This is allegedly stemming from a hard push by nursing homes to bring in more Medicare dollars by attracting patients that otherwise don’t need nursing homes, such as those needing short-term care of rehabilitation, rather than the typical long-term care.

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May 16, 2015

DOJ Intervenes in Medicare Fraud Suit against Major Nursing Home Owner

by Levin & Perconti

In recent news, the U.S. Department of Justice (DOJ) announced that it would join a false claims lawsuit against HCR ManorCare, which is one of the biggest nursing home chain operators in the country. The company has been accused by a whistleblower of consistently overbilling Medicare, including for reimbursements for resident rehabilitations that were too difficult and thus unnecessary for frail residents. This was also to justify higher reimbursement claims to increase revenue, since the level of rehabilitation often hit the highest reimbursement rate level under Medicare.

As the AP reported based on the lawsuit, one example of the alleged fraud occurred when a man who was prescribed hospice care was instead put through over three months of therapy by the nursing home just to qualify for Medicare reimbursements. It is also alleged that nursing homes kept residents for longer than they needed to be there to continue billing the government for care services. The initial lawsuit was filed by an occupational therapist at one of the facilities who saw the alleged fraudulent activity, and there were other suits, all of which have been consolidated into one lawsuit now that DOJ has decided to get involved after years of investigating. DOJ’s involvement may signal its confidence in the strength of the suit after having looked into the matter for a substantial period of time. ManorCare has denied that the billing was fraudulent.

False Claims Act - Rooting Out Fraud

The False Claims Act is a vital piece of law that allows the federal government to claw back money, plus additional penalties and damages, from private entities or persons that reap financial benefits as a result of committing fraud against the United States. This is a very common scenario in the context of medical providers and Medicare and Medicaid claims, as false billing or overbilling Medicare and Medicaid reimbursements for treatments and visits that did not occur or were unnecessary yields unearned profits and thus defraud the government and taxpayers. Nursing homes unfortunately can be offenders, and facilities and individuals can face civil and criminal liability and penalties for such actions. Nursing homes often rely on substantial revenue streams from these government programs, but some unfortunately take advantage of this. Such actions defraud the government and jeopardize the health, safety and well-being of patients who are given medications or treatments that they do not need simply to run up the reimbursement bill.

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May 14, 2015

Abuse of Dementia Patient Leads to $1.2 Million Jury Award

by Levin & Perconti

Out of Oklahoma, which is one of the worst states in the country for nursing home quality of care, comes another incredibly sad story of nursing home abuse that has resulted in some form of justice, though not one that can ever change what happened. The daughters of a 96 year old nursing home resident, who suffered from dementia, sued the facility when they discovered evidence that their mother was abused by two staffers at the nursing home. The lawsuit proceeded in federal court, and resulted in a jury verdict for $1.2 million. As reports indicate, defense attorneys for the nursing home intend to appeal the verdict, which they characterized as “excessive.” The staffers were fired, but that was the least of their punishments. One of the accused aids, who reportedly was in the U.S. illegally, was arrested and charged criminally, and eventually plead guilty and was sentenced to serve two years behind bars. The other worker fled.

The Nursing Home Abuse

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May 11, 2015

Nursing Home Faces $100,000 in Fines after Man Left in Sun Later Dies

by Levin & Perconti

In a report coming out of Naples, Florida, the government fined a nursing home $15,000 after one of its residents became severely dehydrated, suffered a heart attack, and died last August. The cardiac event and death of the resident occurred two weeks after the 90 year old was left outside under the hot Florida sun for close to three hours. Three nursing home employees were fired after this occurred, and the state Agency for Healthcare Administration investigated and released a report on the nursing home detailing concerns that residents could suffer physical injury, illness, and even death as a result of abuse or negligence at the home. One particular area of concern included the facility’s failure to properly supervise and observe residents when they were outside in the facility’s courtyard.

While accounts seemed to indicate the resident wheeled himself into the sun after he was brought outside, nevertheless staff allegedly failed to ensure he was not in the sun for too long and that he would be moved into the shade or back inside. The resident’s temperature reportedly hit an astounding 107 degrees after that, he suffered burns from the sun, and he was very dehydrated. Nearly ten days later, he had the heart attack and was dead. Any person needs to be kept out of the sun for too long, especially a 90 year old, and this victim in particular already suffered from atrial fibrillation, coronary disease, and high blood pressure, indicating he had preexisting heart problems that made close monitoring even more vital.

Problems for the Facility

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May 9, 2015

Texas “Three Strikes (And You’re Closed) Rule” Passes Senate

by Levin & Perconti

As the members of the baby boomer generation age and will undoubtedly create an increasing demand for health care, including at nursing homes and long-term care facilities, state governments and the federal government appear to be looking for ways to help regulate nursing homes and ensure more protection and safety for facility residents. This is especially important where so many nursing home owners are so focused on their bottom line that they are willing to cut overhead, which includes keeping staff at disturbingly low levels in order to save money, all the while overtaxing the existing aides with too much work. Such scenarios unfortunately can lead to abuse and neglect against patients, which also can occur even at seemingly normally staffed nursing homes.

As part of increased oversight, the federal government has given its review and rating process for nursing homes more teeth, and states in general have sought to find ways to strengthen regulations and come down harder on offending facilities or individual aides and staffers. Illinois’ push toward allowing nursing home residents to keep cameras in their rooms to surveil what goes on is one such example of trying to better protect residents. For months, Texas, which is also one of the worst states for nursing home quality care in the country, there has been a push to enact a bill that would make it much easier to close a nursing home if it is found to have multiple violations of the law or regulations. This is called the “Three Strikes Rule” bill.

The Details of the Law

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May 7, 2015

New Details in New Mexico Suit against Nursing Home Chain Owner

by Levin & Perconti

Earlier this year, we discussed the lawsuit filed by the New Mexico Attorney General in December 2014 against major nursing home chain owner Preferred Care Partners Management Group L.P., which is based out of Texas but operates in ten states throughout the Southwest, Midwest and Southeast United States. The initial filing alleged that nursing homes owned by Preferred Care have failed to meet federal and state regulations, and residents have suffered injuries, malnourishment, dehydration, and poor hygiene as a result of the tremendous negligence of facility aides and staffers. Some patients are even said to have died in these circumstances.

Many of these homes employ dangerously low levels of staff, which is unfortunately a trend in the industry whereby owners cut down on costs of employment, and can thereby increase their profit margins. The downside, obviously, is that residents receive less care than they need with few staff around, many staffers are overtaxed and overworked, and unfortunately some resort to abusive or at least improper activities to deal with patients that may be efficient but can also lead to injury or illness. These problems can also be caused not just by understaffing, but by a lack of training. Whistleblowers from these facilities have reported such low staffing levels that keep them from tending to residents in an adequate and timely manner.

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May 4, 2015

Nursing Home Costs Skyrocket

by Levin & Perconti

In a recent report picked up by multiple news outlets, it has been estimated that the median cost for a single private room at a nursing home in the United States is a whopping $91,250 per year, after the median cost was last year tabbed at $87,600 per year. The cost was apparently calculated based on data from the nursing home industry. Genworth Financial, which deals in financial planning for long term care and life insurance, issued the report, which revealed a 4% annual increase in cost for the previous five years. The report focused on data from 15,000 nursing homes and assisted living facilities across the United States. While costs naturally are different among different regions and states, with one state having a median cost of just over $60,000, and another exceeding $280,000, the unmistakable trend is that costs overall are rising and rising.

The Looming Problem Worsens

The immense rising costs of nursing home care will only serve to complicate matters as more and more individuals enter their golden years and the demand for care increases substantially. This challenge is further compounded by facilities that grossly understaff in order to cut costs and increase profits, leading to negligence, possible abuse, and an overall low quality of care for residents. This can inevitably lead to higher costing consequences like further illness, injury or death. And as some state governments, including Illinois, seeks to slash budgets and reduce deficits, public benefits bear a substantial brunt. In Illinois, for example, Governor Rauner has proposed a budget that will decrease Medicaid, which adversely affects funding for nursing homes, as well as cuts to home services which also affects those who would receive such services in lieu of nursing homes. Nothing is set in stone and the legislative negotiations will continue on that budget, but this is an example of the cutting of budgets in spite of rising costs.

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May 1, 2015

Cutting off Nursing Home Funding Is Not Just a Veiled Threat

by Levin & Perconti

A couple of months ago, Tennessee state authorities investigated a nursing home in Memphis that has been a repeat offender of nursing home regulations, and is rated with only one star out of five on the federal government’s rating scale, the details of which are also published on Medicare’s Nursing Home Compare website. As reported by local news in February, the home’s prior August 2013 survey alone cited 14 deficiencies ranging from providing inadequate or improper nutrition to errors with medications to evidence of expired food still hanging around the kitchen. There was also a report that a patient was deprived of prescribed morphine (pain medication) by staff, causing the patient tremendous harm. State authorities spent what was characterized as an unusually long amount of time (weeks) surveying the facility to follow up on patient complaints and presumably to ensure that known errors were fixed and that the facility was generally up to code.

Now, after months of complaints and extended surveying by authorities, the nursing home will lose its federal funding as the federal government will no longer reimburse for care and treatments provided (or ostensibly provided) by the facility to patients. As a result, those patients had to be moved to other facilities so they can continue to receive care that can be paid for with federal funds through programs like Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS), which administers those programs under the auspices of the U.S. Department of Health and Human Services, indicated it would officially cut off the funds as of April 11, 2015.

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April 29, 2015

Connecticut Nursing Home Workers Vote to Strike

by Levin & Perconti

The nursing home industry in many areas has been challenged by complaints of abuse and neglect by aides, state and federal surveys and investigations with the possibility of sanctions that go so far as denying licensure, as well as the uncertainty as to sources of funding to pay for care at these facilities. These issues and accompanying discussions are often framed in terms of the lasting and consequential effects on facility residents, and the disciplinary actions taken against a nursing home and/or specific nurses or aides. In Connecticut, however, there is news of specific action that nursing home workers are taking to protect themselves from their employers and a threatening state budget proposal.

In the state of Connecticut, in earlier April, a significant 3,500 employees from 27 different nursing homes agreed to go on a workers’ strike starting the last week of the month. Local reporting details the primary motive as protesting the state government for its budget that may threaten reimbursements to nursing homes through federal insurance programs like Medicaid, which is typically a tremendous source of income for nursing homes. Connecticut’s governor has proposed a budget that would eliminate a previously planned cost-of-living increase that is factored into reimbursements to medical providers for care given to Medicaid insurance recipients. As indicated in an article, approximately 70% of nursing home residents in Connecticut are covered by Medicaid insurance, and cuts to that would obviously take away from money going to the facilities, which in turn are used to in part pay employees’ salaries.

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April 27, 2015

Illinois Camera Bill Passes through Committee

by Levin & Perconti

The State of Illinois has taken a role toward the front of the progressive nursing home camera movement. A few states across the country already have laws on the books permitting nursing homes operating in their respective jurisdictions to allow patients and their families to place surveillance cameras in the patient’s room if they choose to do so. The advantages should be obvious: cameras capture footage of abuse and neglect (for example a physical hitting, or a long lapse of time in which no staffer comes to check on the patient), and allow patients and their families to know what is going on, and to put a stop to it and hold the right people accountable. In most cases signs must be posted warning visitors and staff that there is a camera in a particular room, thus this also serves as a deterrent to one who might otherwise commit abuse, neglect the patient, or steal from the patient.

Some decry this permission as creating concerns over the privacy of visitors, but posting of signs at least provide notice to individuals that they are being taped. And such laws and policies typically ensure that where residents share a room, that consent is provided by roommates and their families where necessary in order to have a camera placed in the room. The Madigan proposal ensures such consent, requires residents and families to pay for the equipment, ensures that footage can be admitted in legal proceedings, and prohibits anyone from retaliating against a resident for using monitoring equipment or tries to tamper with or prevent the use of the cameras.

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April 24, 2015

Resident’s Fall and Death at Low-Rated Illinois Nursing Home Raises Questions

by Levin & Perconti

In Southwest Illinois, at the Midwest Respiratory and Rehabilitation Center in Belleville, there was a horrific and tragic death of an 85-year old resident at the facility. According to local report, the victim “was found dead strapped to a wheelchair at the bottom of a flight of stairs.” The tragic death occurred in the early hours of March 12th. In addition to the possible negligence that led to this, the victim’s sisters reportedly noticed signs of abuse such as cuts, bruises, and stitched up areas on the victim’s body.

Authorities Notified First by the Funeral Home, Not the Nursing Home

Rather than the nursing home facility informing authorities of her awful death, it was a local funeral home, over an hour away, which had retrieved the body after the victim’s daughter made a call to the funeral home. The funeral home called the county medical examiner to clarify how the death certificate should be filled out because if there were an accident (as opposed to natural causes), this would require the medical examiner to establish a cause of death and sign off on the death certificate. The medical examiner subsequently went to pick up the victim’s body. Reportedly, the only call to authorities from the nursing home was for an ambulance.

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