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Former Nursing Home Resident Unnecessary Tracheotomy Case Leads to Criminal Complaint

There is often a close relationship between hospitals and certain nursing homes. Seniors who live in nursing homes usually have various medical issues which may require hospital care on a frequent basis. In fact, some of the most common forms of nursing home neglect is when caregivers fail to call an ambulance to rush a resident to a hospital to receive emergency care. It is critical to remember that nursing homes, while providing some skilled care, are not hospitals. These facilities are limited in what care they can provide, and it is incumbent upon caregivers at these homes to know when it is necessary to transport a resident to a hospital.

But therein opens another problem. Because nursing homes are such a large referrer of patients to hospitals–and both may be for-profit facilities–there is a risk of fraudulent relationships developing. That may include situations where residents are referred to certain facilities at certain times in order to boost the bottom line of both operations. In the worst cases, administrators may actually provide kickbacks to nursing homes for referring residents to one hospital over another.

Illinois Example
For example, this summer a shocking Medicare and Medicaid fraud case broke in the Chicago area involving Sacred Heart hospital. The main allegations in the case, as reported in a Bloomberg story, are that tracheotomy procedures were performed on some patients unnecessarily. Those procedures may even have led to untimely patient deaths. Sources claim that the procedures were performed simply to boost the hospital’s bottom line–reimbursement rates for tracheotomies are quite high.

The case involves hospital doctors and administrations, but there is a strong nursing home connection that is important to highlight. The criminal complaint which was filed this summer against several involved individuals discusses how different parties viewed nursing homes simply as a referral source (and moneymaker) for the hospital.

For example, one doctor named in the complaint served patients at various nursing homes throughout Chicago. Known by some at Sacred Heart as the “king of nursing homes,” this doctor began to milk his referral power for personal gain. In short, the criminal complaint alleges that the hospital provided various benefits to the doctor in order to receive as many referrals as possible to increase profits. Those benefits ranged from providing “gifts” to be redeemed at an expense steakhouse to paying 70% of the salary of the doctor’s physician assistant.

Those close to the situation allegedly explained that all of the doctor’s nursing home patients were sent exclusively to Sacred Heart. Other allegations suggest that the facilities developed policies of admitting nursing home patients to the hospital even without actual medical need.

In short, this is but one example were serious allegations are made about a fraudulent relationship between nursing home and hospitals. It is simply inexcusable for anything other than the best interest of the medical patient/nursing home resident to factor into medical decisions. It is incumbent upon senior care advocates of all stripes to do what is necessary to prevent this abuse. Be sure to keep a careful eye on hospital admissions of nursing home resident and speak up when potential trouble is spotted.

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