An entity owning a chain of nursing homes has become the latest to settle with the United States government over allegations that it fraudulently billed the government for Medicare and Medicaid reimbursements for what has been described as “substandard” care to those nursing home residents. The entity called Extendicare Health Services Inc., owns the Arbors of Sylvania nursing home in Toledo, Ohio, and others around the country.
It has been written up by health authorities for a variety of alleged violations of regulation in failing to properly care for residents. Among the various allegations, the nursing home was accused of allowing patients to become dehydrated and malnourished, and in at least one case failed to properly take care of a patient in his or her use of a catheter, which for those familiar is a very serious medical device. In other instances, nursing home staff did not give patients their medications. To add to the mess, there were also incidents of patients falling due to allegedly negligent care and poor attention on those patients.
Violation of Federal Rules
Such instances and failures to properly care for patients themselves implicate state and federal rules and regulations. A nursing home exists for the pure reason of providing care to those who are ill, injured, or otherwise physically or mentally disabled and cannot care for themselves or have families who in spite of loving them are unable to give the proper care needed at home. So when there are falls, missed medications, failures to use or to adequately use necessary medical devices, and general incidents of failing to feed or provide fluids for patients, a nursing home and its staff have completely and utterly failed at this mission. In the case of the Arbors of Sylvania, for example, according to U.S. News and World Report, the facility underwent inspections as recently as April 2014, garnering less than stellar marks. It fell below the state average and more so below the national average, as it failed to “develop a complete care plan that meets all the resident’s needs” and failed to “assist those residents who need help with eating/drinking, grooming and personal and oral hygiene.” Furthermore, it failed to make sure that each resident’s medication regimen did not contain unnecessary medications and that the regimen was closely monitored.
The recent news, of course, focused more on the accused fraud involving the federal government. Extendicare Health Services receives money from the federal government to cover costs of treating and caring for Medicare and Medicaid insured patients at its facilities such as Arbors at Sylvania. The company in general was accused of billing Medicare and Medicaid in spite of offering inadequate quality of care and services to residents. As the Ohio Attorney General put it, the services “were so deficient that they were effectively worthless.” By not providing the proper service yet still billing the government, this allegedly constituted a fraud upon the government, thus triggering jurisdiction under the False Claims Act. This law is largely used to go after all kind of companies and people, and is a key weapon in the fight against healthcare fraud.
The company came to terms with the Department of Justice and relevant state authorities on a $28 million civil settlement (there was no criminal action) to resolve the allegations regarding its improper billing for services at Arbors at Sylvania and five other facilities in Ohio, as well as 27 other facilities across its U.S. nursing home network. Another $10 million was tacked on for Extendicare’s providing unnecessary rehabilitation to patients and billing Medicare for it. The federal government will receive about $32 million, with the affected states receiving the rest. And Extendicare must use an independent monitor for five years to ensure compliance with rules as part of the deal. This is yet another example of an active DOJ investigating nursing homes, their level of care, and their allegedly improper billing.
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