Articles Posted in National Nursing Homes

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James Burkhart, the former CEO of American Senior Communities (ASC), Indiana’s largest nursing home chain, has just been sentenced to nearly 10 years in federal prison.

“Obsessed with Money”

From 2009 – 2015, Burkhart and several other high-ranking ASC executives engaged in a moneymaking scheme that included kickbacks and overcharging vendors, charges to which Burkhart pled guilty. Burkhart and his associates made $19.4 million during that time period, with $10 million taken from Indiana’s public health system.

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The Elder Justice Coalition is reacting to a July 7th New York Times article that outlined just how extensively nursing homes have hidden low staffing numbers. The advocacy group is calling for an immediate congressional review of staffing practices within nursing homes.


Actual Payroll Data Reveals Staffing Crisis

The article, investigated and published in collaboration with Kaiser Health News, was based off a review of payroll hours submitted to the Centers for Medicare and Medicaid Services (CMS).  The actual hours made news not only because they show a serious crisis in terms of resident to staff ratios, but also because up until recently, nursing homes had supplied their own staffing data to CMS. With the new payroll-based submission process, nursing homes have no ability to fudge numbers.

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Just last week, the Pennsylvania House of Representatives voted down extending the Medical Care Availability and Reduction of Error Act (MCARE) to nursing homes and assisted living facilities in the state. Among other provisions, the MCARE Act currently caps punitive damages against doctors, hospitals, and healthcare providers to 200% of the amount awarded for compensatory damages in medical malpractice lawsuits. The latest version of the bill sought to limit punitive damages against nursing homes to 250%. Punitive damages are dollars awarded to a victim with the intent to punish the party responsible for causing injury. Punitive damages are also intended to deter the likelihood of similar incidents occurring in the future.

Damage Caps: A Solution to a Non-Existent Problem

Robert L. Sachs, Jr., a Pennsylvania personal injury attorney, told the Penn Record that nursing homes are “asking for protections that already exist, and they’re asking for protections…as a cure for a problem that hasn’t even been diagnosed.” Sachs goes on to challenge Pennsylvania nursing home defense attorneys to pull up 5 awards composed of large punitive damages.

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The rules are changing yet again for nursing homes who have been negligent, and not for the better. On June 15th, the Centers for Medicare & Medicaid Services’s Safety, Quality, and Oversight group sent a memo to state survey agency directors telling them to lighten up on nursing home punishments. The theme of the memo seems to be more “keep things moving” rather than “fix things for the long run.” The new rules will go into effect on July 15th.

Prior to the new changes, nursing homes who had any health or safety violations were punished in accordance with federal guidelines. Now the decision of how and when to punish facilities is being put into the hands of CMS’ regional offices, with the exception of a handful of circumstances.

Enforcement of Punishments for Immediate Jeopardy Violations

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nursing home evictions

Nearly 37,000 Medicaid Recipients Receive Discharge Notices in Louisiana

A chaotic and stressful situation is consuming Louisiana’s Medicaid program. The issue is targeting nursing homes and long-term care facilities as more than 35,000 recipients could lose their benefits and be forced to evict due to proposed state cuts and a lack of state funding.

Louisiana Department of Health Deputy Secretary Michelle Alletto said the agency has notified about 37,000 Medicaid recipients that they may face eviction or discharge if eligibility to receive the benefit ends on July 1. Many of these patients have dementia and memory loss diseases, and developmental disabilities which require consistent, routine care. The proposed cuts could also force nursing homes to close or create even more shortages of trained care staff and cuts to an already overburdened and underpaid workforce. This reality is the result of the Federal government’s February 2018 budget proposal aimed to implement cuts to Medicaid and subsidies in favor or cost savings and will force states officials to make hard choices that are sure to impact the delivery of Medicaid programs across the country.

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national health disparity month

April Is National Health Disparities Month

The National Institutes of Health (NIH) estimates nearly two-thirds of individuals who rely on federal and state funding to support their healthcare and long-term care services have multiple chronic conditions. Most of these conditions impact specific racial and ethnic minority communities who have disproportionately been supported with the appropriate diagnosis and treatment needed to thrive. As April marks an opportunity to call attention to these issues under National Health Disparities Month, it’s an important time to start discussion about the significant problems we have in the United States and right here in Illinois, in relation to at-risk populations who receive Medicare or Medical Assistance to treat chronic diseases. These groups are currently battling greater morbidity, mortality, and disability rates as a result of their long-term care coverage.

According to Centers for Medicare & Medicaid Services (CMS), Medicare and Medical Assistance (Illinois’ name for Medicaid) populations that experience disproportionately high burdens of disease are provided worse quality of care, and barriers to accessing long-term care than others. CMS officials say, “these populations include racial and ethnic minorities, sexual and gender minorities, persons with disabilities, as well as individuals living in rural areas.”

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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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In a previous blog post, we discussed a 2011 jury verdict that awarded approximately $92 million to the family of a patient who suffered abuse during a 3 week term at a West Virginia nursing home called Heartland Nursing Home, which is owned by a corporation called Manor Care. A relatively small amount of the jury award accounted for ordinary negligence in the nursing home’s actual poor medical care and negligence in failing to adequately feed and hydrate the patient. A whopping $80 million of that award accounted for punitive damages. An obstacle to enforcement of the jury award was found in West Virginia’s professional liability laws that limit non-economic damages (i.e. punitive damages, as opposed to more easily quantifiable medical costs), to $500,000, which was obviously well below the award given by the jury. When we last discussed this case, it had crept its way to the state Supreme Court to determine the issue of whether or not the verdict was appropriate under the half million dollar cap for professional liability. To date that question has not yet been answered while other in-state nursing home negligence claims lay dormant awaiting a ruling before proceeding to their own jury awards.
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The line between the type of care provided at a nursing home and the care provided at a hospital is sometimes not easy to distinguish. The traditional long-term care unit is a “skilled nursing” facility, meaning that more medical care is provided than at mere assisted living facility but less skilled care than at an actual hospital. As a result, nursing home abuse or neglect lawsuits can involve general caregiving lapses (like allowing a senior to fall) or actual medical errors (like not providing certain treatment in a timely fashion).

Importantly, even lawsuits against hospitals can take both forms, either problems with the medical treatment itself or with basic caregiving and monitoring of patients. For example, our team of neglect lawyers recently settled a case on behalf of a client against Rush Medical Center following failure to monitor a patient after a CT scan was performed

Chicago Malpractice Lawsuit

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This week–May 12th through May 18th–represents the official “National Nursing Home Week.” With many participants, including the American Health Care Association (AHCA), the event is a yearly reminder of the needs of long-term care residents and the terrific work that so many valuable caregivers perform day in and day out. It is easy for those of us working on matters related to nursing home neglect and mistreatment to appear unconcerned with the great work that facilities are able to provide. But on the contrary, because we are so familiar with the many instances of poor care, we are better able to understand the value and service of great care, when it exists.

The theme of this year’s week-long event, according to the AHCA site on the event, is” “Team Care.” In summarizing the event, the site explains that the week is for the residents and dedicated staff who “pitch in for optimal outcomes.” This is a timely theme, as with the complex needs of many seniors, proper communication and shared commitments to positive outcomes for senior residents requires clear coordination between all members of the caregivers process. When too many nursing home employees are forced to go it alone or do not receive the support they need for owners and operators, harm results.

National Nursing Home Week Events