Articles Posted in National Nursing Homes

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nursing home disaster plan

Healthcare Facilities Should Be Prepared for Natural Disasters

Although new Medicare and Medicaid guidelines were set in place after the tragic deaths of over 100 nursing home residents during Hurricane Katrina, cases of patients left behind due to natural disasters such as wildfires, tornadoes, or floods are reported each year. These occurrences are starting to prompt health care officials to raise concern over the need for better public policy support, emergency planning resources, funding, and protections for vulnerable long-term care residents in the event of an emergency prompted by catastrophic events and conditions that threaten their well-being such as no internet and no electricity.

A recent federal review of Centers for Medicare & Medicaid Services (CMS) records found that:

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“Frail and vulnerable people are harmed when nursing homes fail to meet our standards. And I don’t think any of us wants to wait until the next natural disaster or other disaster exposes some kind of a deficiency that kills dozens of people.”

                                                 -Rep. Diana DeGette (D-CO)

On Thursday, the House Subcommittee on Oversight and Investigations held a hearing to address substandard care and recent findings of abuse and neglect in U.S. nursing homes.

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Nursing Homes May Transfer Ownership to Hide Questionable Care

In the aftermath of a resident accident, report of abuse or neglect, or serious complaints against staff, a nursing home’s lease or title may simply be transferred to another company as a way to position a band-aid over real issues. When nursing home facilities are often bought, resold and rebranded, families of residents should raise questions about whether administrators or staff are to blame.

“A May 2016 article in the Boston Globe highlighted the findings of a Harvard University study on the impact an acquisition has on nursing home quality. The study found that there was a direct link between the number of times a facility had changed hands and the number of state violations it had. The authors ultimately concluded that the changing of hands wasn’t the cause, but the fact that the facility itself was plagued by troubles and that changing ownership did little to improve it.” – The Centers for Medicare & Medicaid Services

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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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