October 22, 2009

Center for Medicare Reins in Overpayments to Skilled Nursing Facilities

For many years, the Medicare Payment Advisory Commission has reported that the Medicare program overpays skilled nursing facilities (SNFs) for rehabilitation services and underpays SNFs for certain residents needing specialized services and skilled nursing care. Significant changes will be made to Medicare payment policy and rein in wasteful spending and overpayments. Many times SNFs are paid for services they do not provide. Additionally, the programs were supposed to be budget neutral, but SNFs placed more residents in the highest assessment categories which resulted in overpayments. To read more about the overpayment, please visit the center for Medicare advocacy’s website.

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September 11, 2009

Audit Finds Illinois Overcharging for Long-Term Care

An audit says Illinois could be overcharging thousands of nursing home residents who rely on Medicaid to pay long-term care expenses. A report by the Auditor General shows that one patient was overcharged $9,204. The nursing home report says the state’s Healthcare and Family Services and Human Services departments are automatically applying increases in Social Security benefits to care; federal law allows patients to give the money to spouses still living at home. The program spans at least 57,000 residents at 750 nursing homes. The agencies contended they are updating computer programs, and that no actual clients have been affected. To read more about the nursing home misspending, please click the link.

August 31, 2009

Three People Arrested for Operating Unlicensed Assisted Living Facilities

Three people have been arrested following an investigation by the Medicare Fraud Control Unit. The attorney general announced that three nursing home administrators were arrested on charges that they were operating two different assisted living facilities without licenses. The office started getting complaints about the nursing home and launched an investigation. Two of the administrators face felony charges and the potential for up to five years in prison if convicted. Investigators say that one of the operators had a licensed facility, but it exceeded its capacity. She then placed the extra clients in an unlicensed facility and asked for Medicaid reimbursement. The woman also received a cease and desist order and faces three charges: operating and/or maintaining an assisted living facility without a license, Medicaid fraud and grand theft. Unlicensed facilities can pose a serious threat to the residents’ safety and well-being. If your loved one has been a resident in an unlicensed nursing home, find an Illinois lawyer. To read more about the Medicaid fraud, please click the link.

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October 31, 2008

Nursing Home Resident Files Class Action Lawsuit Alleging Fraud

A nursing home resident filed a federal lawsuit alleging consumer fraud by a Milwaukee-based care chain with eight facilities in Minnesota. The suit was filed on behalf of as many as 1,400 residents of the eight Extendicare homes. The suit was filed by a woman who says Extendicare promises more than it can deliver, resulting in increased earnings yet poor care for residents and hundreds of rule violations in Minnesota. The suit alleges that state inspectors have cited the homes for 218 violations in the past two years. The state average is 10 violations per year. The class-action suit seeks restitution of approximately 40 percent of the fees paid by private-pay residents. Extendicare dismissed the allegations stating they were “false and misleading”. The suit states that Extindicare lured clients in by promises it could not provide, and sought out high-need residents to increase profits, regardless of whether they could meet their needs. Two months ago, a similar class-action lawsuit was filed in Seattle. To read the full story, click here.

September 14, 2008

Feds Probing Complaint at Illinois Nursing Home

An anonymous complaint brought federal investigators to an Illinois nursing home. The U.S. Department of Health and Human Services sent investigators from a Medicare/Medicaid fraud unit to the nursing home. The unannounced visit is part of an ongoing investigation which arose from an anonymous complaint. Illinois has a Medicaid Fraud Control Unit that investigates and prosecutes Medicaid provider fraud and incidences of patient abuse and neglect. The nursing home had faced closure earlier in the year after the state found several deficiencies and halted Medicare/Medicaid reimbursements for new patients until the deficiencies were corrected. Less than a week later, the state had cleared the nursing home after receiving a corrective-action plan. To read the full story, click here.

Nursing Home Denies Rights to Residents

Health deficiencies continue to be found at a nursing home where residents are not being informed of their legal rights. In 2005, the U.S. Department of Health and Human Services inspected the nursing home and gave it an overall rating of needing corrections. Deficiencies in the quality of care, resident’s rights and physical environment were found and reportedly corrected but when the facility was inspected last year, it was found in compliance. However, a recent inspection found that the nursing home failed to inform residents of their legal rights, services and charges. The nursing home failed to tell each resident who can get Medicaid benefits about which items and services Medicaid covers and which the resident must pay for or even how to apply for Medicaid. The nursing home faces other charges as well, such as not informing patient’s families when they have been admitted to the hospital. To read the full story, click here.

May 19, 2008

GAO Report Finds Faults with Current Nursing Home Compliance System, Recommends Changes

The GAO has released a study on the results of federal monitoring surveys of state inspections in nursing homes. The federal government often contracts with state employees to perform annual compliance surveys which are a prerequisite to Medicare and Medicaid funding. The GAO’s report unfortunately contains some very troubling reports of nursing home abuse and neglect.

The study found that a substantial proportion of state inspectors and surveys miss deficiencies in nursing homes regularly, including malnutrition, severe bedsores, overuse of prescription medications and nursing home abuse and neglect. Some of these deficiencies are at the most dangerous levels and could cause immediate harm to nursing home residents. However, less serious noncompliance was more frequent: approximately 70% of state surveys missed at least one instance of low-level noncompliance.

Click to view the full text of the study or the abstract.

Continue reading "GAO Report Finds Faults with Current Nursing Home Compliance System, Recommends Changes" »

May 7, 2008

Attorney General Seeks Out Home Healthcare Staffing Problems and Medicare Fraud

Attorney General Andrew Cuomo has joined the fight against fraud in home health care by exposing a large Medicare fraud led by a major home health care corporation. The corporation provides in-home nursing services. In-home nursing service abuse is a growing problem and is often harder to identify than nursing home abuse and neglect. In this case, the home health care corporation coordinated with corrupt health care aide training programs to certify prospective health care aides without ensuring that the prospective aides took required training courses. This incident raises questions about the quality and safety of in home nursing care and should give family members and home care customers pause for thought.

Read the full story here.

May 5, 2008

Medicare May Cut Nursing Home Payments to Trim Budget

The Centers for Medicare and Medicaid Services (CMS) has threatened to cut its payments for nursing homes by 0.3%. Though the percentage seems small, the economic consequences in the nursing home industry will be much larger. This cut could usher in a total of $4.2 billion and has nursing home industry financiers attempting to figure out what these cuts could look like to nursing home profits for the next few years. Unfortunately, profit often seems the only priority for operators of large nursing home chains. All too often, profits are placed above patient and resident care and can lead to cases of nursing home abuse and neglect, and even nursing home resident deaths.

Read more here.

April 25, 2008

Illinois Nursing Homes at Risk with Threats in Medicaid Reductions

Proposed changes to federal funding for Medicaid could cost Illinois more than 10,000 jobs and over $400 million in lost wages. Over the next five years, Illinois could see upwards of $2.5 billion in lost funding. Critics of the federal plan warn that reductions in Medicaid funding will shift the bill to the state in an already shaky economy. For Illinois nursing homes
this reduction in Medicaid is a serious threat to resident care and could lead to increased incidents of nursing home abuse and neglect. For instance, a nursing home in Peoria illustrates the problem: more than 70% of its residents are Medicaid funded. Many nursing homes and their residents that count on Medicaid may have to make alternative arrangements if the budget cuts go through.

Read more here.

January 30, 2008

Elders susceptible to financial abuse and fraud due to neuropsychological deficits

Elder financial abuse and fraud is one of the most common types of abuse and neglect inflicted upon senior citizens. New evidence has shown that aging of the brain, and not gullibility, loneliness or intelligence, can make elders vulnerable to financial exploitation. A recent University of Iowa study has shown that medical or neurological problems in the brains of the elderly can lead to an increased vulnerability to financial abuse and fraud. A significant percentage of elderly participants in a study showed disproportionate signs of aging in the brain region responsible for decision-making. It is important to protect elders from financial abuse and fraud because they may not be able to do it themselves.

Click here for the full article

January 13, 2008

Be aware of the many types of elder abuse and neglect to help keep seniors safe

There are many different forms of elder abuse and neglect and it is important to watch for signs of abuse in order to protect loved ones. Anyone over age 60 can be a victim of elder abuse. Elder abuse and neglect comes in many forms:

-Physical abuse
-Emotional abuse includes verbal assaults, threats, intimidation and harassment
-Confinement is restricting an elderly person without their consent. Many believe that restraining seniors with Alzheimer's or other illnesses should be restrained in order to prevent wandering off. This is illegal and there are better alternatives
-Passive neglect is when a loved one, caregiver, nursing home or assisted living facility is unable to provide a senior with the care they need. This can include failing to provide medication at appropriate times, causing malnutrition or dehydration by forgetting meals, allowing falls due to lack of supervision, allowing bed sores to develop as a result of neglect, failing to monitor the hygiene of the elderly person and more.
-Financial exploitation is the misuse of a senior's money, accounts, insurance, etc. It is the most commonly reported form of elder abuse. Many different types of people can exploit elders financially including family members, caregivers and employees of nursing homes or assisted living facilities.
-Sexual abuse is any type of sexual act or conduct performed against the elderly person's will.

If you are aware of elder abuse or suspect that a senior is being abused, call the Illinois elder abuse hotline at (866) 800-1409. It is available 24 hours a day.

January 12, 2008

Medicare & Medicaid fraud prevalent in nursing homes

A new study by Americas Watchdog's Corporate Whistleblower Center shows that "things have never been worse" in the realm of Medicare & Medicaid fraud. All aspects of health care are included (click here to read more) but nursing homes make up a large portion of fraudulent behavior, magnifying the problem of nursing home neglect. Long term care facilities, nursing homes, and rehab centers have proven to be a huge drain on the American taxpayers based on fraudulent conduct. In the nursing home field, there is a mandatory minimum amount of hours that must be spent caring for each patient, each day. However, less than 50% of patients are getting the required amount of care. In addition to fraud, nursing home neglect is a serious problem and American tax dollars are paying for it! The Whistleblower center states that, "senior citizens are dying in US nursing homes, because they are in many cases not getting anything close to mandatory time/hours per day in care." Unnecessary testing of patients has also proven to be a problem of fraudulent behavior. An estimated 35% of all testing performed in nursing homes, mainly in areas like speech or cognitive testing for instance, is necessary.

Click here for the full article

December 29, 2007

Son charged with stealing elderly mom’s income

A Maine County grand jury indicted a Hampton man on charges that he stole thousands of dollars of his mother’s income while she was in a nursing home. The man charged is alleged to have stolen more than $13,000 between June 2006 and May 2007. Prosecutors allege that the man who held his mother’s power of attorney at the time, took her money for his own use instead of paying his mother’s nursing home bills. The Medicare Fraud Unit, a unit that investigates health-care provider fraud and allegations involving financial exploitation and physical abuse of long-term care residents, is prosecuting the son.

For the full article.

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November 19, 2007

New York nursing home employees threaten to strike after nine years without a new deal

Nine years have passed with a nursing home employee union trying to get a contract at the Ruby Weston Manor in East New York. Now, the nursing home union has had it: if there is not contract by November 27, they have authorized a strike. A member of the union, stated that “We take care of the [nursing home] residents. [The nursing home] should take better care of us.” Last December, then-Attorney General Eliot Spitzer filed suit against the CEO of Ruby Weston Manor, seeking her removal as CEO of the two taxpayer-supported nursing homes for the poor. The nursing home abuse lawsuit filed by the Attorney General charged that the CEO had enriched herself and relatives with millions of dollars in self-approved salaries and benefits. Additionally, the lawsuit alleged that the CEO circumvented state not-for-profit laws and had nursing home neglect at the two facilities.

Again, we see CEOs of nursing homes getting rich while the employees and residents suffer. If a nursing home cannot afford caring employees, nursing home residents will undoubtedly endure nursing home abuse and neglect.

For the full article.

November 18, 2007

Useful publications cited in thought provoking blog by Lisa Nerenberg

Lisa Nerenberg, who has been involved in the field of elder abuse prevention since 1983, publishes a blog with posts concerning financial exploitation, identity theft, cognitive impairment and undue influence, care giving issues and cultural and gender issues. A recent post, "Geriatricians, Angry and Otherwise," is a provocative commentary which highlights useful and interesting readings. The readings cover a wide range of topics, including, "the social and economic factors that contribute to elder abuse, including ageism in healthcare, inadequate pensions, and poverty," and a surgeon's description of the field of geriatrics. In addition, Nerenberg includes interesting references to global trends in elder abuse.

Click here to read Lisa Nerenberg's blog

October 22, 2007

Former owner of residence home faces federal indictment for Medicaid and Medicare fraud

A Missouri man connected with a residence home where a fire last year took the lives of 11 people now faces a federal indictment alleging that he defrauded the Missouri Medicaid program. The man is accused of running several residence homes, despite a previous conviction for Medicare and Medicaid fraud. Federal and state law prohibits individuals who are convicted of crimes related to Medicaid and Medicare programs from acting as operators of licensed Medicaid providers or from participating in any federal health-care program. The residence homes operated by the Missouri man served individuals with mental illness or disabilities.

For the full article.

September 28, 2007

Alliance for Quality Nursing Home Care surprisingly refuses to condemn long-term facilities who do not provide quality care

A statement was issued by the President of the Alliance for Quality Nursing Home Care (AQNHC) in response to the New York Times Article released on Sunday in which the AQNHC surprisingly refuses to condemn the practice of providing less than quality care while simultaneously using corporate shells to operate long-term care facilities and avoid accountability. The AQNHC, a group committed to improving the quality of long-term care nationwide, takes the unsupported position that care in America’s nursing homes is improving overall, noting that the New York Times focused their analysis on only 10% of our nation’s nursing homes.

The AQNHC does not deny that care is being sacrificed at these private equity owned homes, nor do they condemn this practice. Further, AQNHC is non-responsive to the issue of accountability where the owners of long-term care facilities - those who reap the profits - are not held accountable for bad care.

Is the AQNHC applauding this practice or not responding at all? One would expect an organization that is engaged in improving care in our nation’s nursing homes to condemn a practice by profit seekers who cut resident services and staff, decreasing the overall quality of care provided to residents.

Instead, the AQNHC lauds the profession’s “demonstrated commitment to public data disclosure,” and transparency, asserting that nursing homes make data available for potential residents to assess the quality of the facility. However, AQNHC forgets that long-term care facilities’ receipt of Medicare funds is conditioned upon reporting this data, making such reporting essentially government mandated.

In essence, the AQNHC applauds long-term care facilities who participate in a government mandated regulatory scheme with no regard for the bad care residents suffer when profits are put ahead of people.

Click here for the statement.

July 24, 2007

Beware: nursing home agreements can contain hidden dangers

It is important for families of nursing home residents to be aware of an important issue: signing nursing home agreements can wind up ultimately costing you large sums of money. The Elder Law Minute brings to discussion the fact that unfortunately, many nursing home admittances occur after a rushed discharge from a hospital, resulting in family members being forced to hurriedly sign mounds of paperwork. In some instances, family members signing papers as the "responsible party" guarantees that the resident's fees must be paid in full- if not from the resident, then from the responsible party. In the Nursing Home Care Act, a nursing home that participates in the Medicare or Medicaid program must not require a third party to guarantee payment. This is why it is important to make sure that paperwork is reviewed by an elder law attorney.

June 26, 2007

Nursing home abuse and neglect runs rampant in St. Louis area homes

A federal lawsuit has been filed against a Texas company which alleges that serious accounts of nursing home abuse and neglect were present in its five St. Louis area homes. Residents suffered from dehydration, weight loss, and bed sores. The seriousness of some of these pressure sores ultimately led to amputations. The suit also cites incidents where residents were allowed to wander and exit the facilities, where the staff failed to administer proper medication, and where the residents were forced to live in unsanitary conditions. The US Attorney alleges that the homes were seriously understaffed. The suit also accuses the company of false and fraudulent billings to Medicare and Medicaid programs.

Click here for the full article