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Nursing Home Lawsuit Makes Accusations of Resident Cycling for Profit

A new nursing home lawsuit filed last week, and reported by Kaiser Health News, makes some troubling allegations about the work of a national hospice company. According to the complaint, the facility in question engaged in unsavory profit-building tactics including the cycling of patients between nursing homes and hospice care. Those leading the effort hoped to squeeze as much money out of Medicare as possible, with the well-being of the residents seen as a secondary goal. These disturbing allegations of nursing home neglect were made public following a former employee’s filing of a whistleblower lawsuit last week.

According to the report, the federal lawsuit which initiated the matter named a hospice company as defendant for practices it claims were engaged in to take money from Medicare fraudulently. The suit claims that the facility pressured its employees to enroll patients at the facility even though those patients were not actually dying. In addition, the home allegedly resisted discharging residents, even when evidence clearly indicated that they were not deteriorating. For example, in the lawsuit the federal authorities share the story of one patient who was enrolled in the hospice program allegedly from end-state heart disease. Someone in hospice care for that condition would be expected to be totally immobile. However, the resident in this case was healthy enough to go berry-picking and attend his granddaughter’s graduation. Clearly the patient should not have been in hospice care.

Our Chicago nursing home neglect lawyers are aware of the critics who have explained that Medicare’s payment system provides an incentive for abuse. This latest hospice lawsuit provides even more fodder for that argument. The lawsuit is only the latest in a series of hospice lawsuits filed by authorities for fraudulent practices. The hospice company named as a defendant in this suit is owned by a parent company that provides skilled nursing care and other services on top of hospice programs.

The whistleblower in this case explained the modus operandi of the company. Apparently they would recruit patients eligible for twenty day skilled nursing care-of which Medicare would foot the entire bill. Then, when that initially stage was up, the patients would be sent to hospice care. The company then collected a flat payment from Medicare for each day that the patient was enrolled in the program. Had the patient stayed in the regular nursing facility, the patient would have been required to pick up part of the costs. At the end of the day the maximization of profits for the company-and not meeting the needs of patients-was the driving factor behind decisions at the home.

The hospice company has denied all of the charges in the nursing home neglect and Medicare fraud lawsuits. They claim that their practice has evolved in years to treating terminally ill patients whose disease progressions are unpredictable. They allege that the health of certain hospice patients is a product of the fact that some diseases are simply impossible to predict perfectly. While the defense argument is possible, it will be hard to counteract the statistics. In certain branches of the company’s hospice program anywhere from 50% to 80% of hospice patients are eventually discharged while alive. It will be interesting to see how the arguments in this case are fleshed out.

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