WFAA had a troubling investigative report on the care provided at nursing homes in Texas.  Part One is here.  Part Two investigates the nursing home industry hiring criminals to care for our loved ones.  A six-month WFAA investigation found 200 aides certified to work in North Texas nursing homes have serious or violent criminal histories.

The most troubling part is that current regulations in Texas allow many certified nurse aides (CNAs) with criminal histories to work in nursing homes legally.  The WFAA investigation found CNAs who have been “convicted of crimes that should make them ineligible to work, yet slipped through the regulatory cracks — and continue to remain state certified and employable.”

The WFAA review found CNAs with arrests for crimes that include the following: aggravated assault with a deadly weapon; continuous violence against family; injury to a child; abandoning a child; aggravated robbery; aggravated sexual contact with a child; and burglary.

There are three major oversight flaws, according to the WFAA findings.

Loophole 1: Inadequate initial background checks

The first involves the initial certification.

The state requires DPS to conduct a criminal background check prior to an applicant being certified. That’s different from Texas requirements in other industries, for example, like child daycare in which a national background check using fingerprints is required.

The WFAA review found the DPS checks apparently fail to uncover various state convictions. That’s resulted in nurse aide applicants getting certified, though they should be barred for life.

Loophole 2: No background check on re-certification

A second flaw appears in the re-certification process. The state requires a nurse aide to get re-certified every two years, yet does not require regulators to re-check a CNA’s criminal background.  Instead, any further background checks fall to the nursing homes.

WFAA found individuals who commit crimes that should bar them from work – and have their certification pulled – yet remain certified and employable.

Loophole 3: Deferred adjudication probation

The third and most common loophole WFAA found is buried in the state’s regulations. It says if you commit a serious or violent crime, you are eligible to become a CNA as long as you don’t have a “final conviction.”  WFAA found dozens of nurse aides who pleaded guilty to violent crimes. But since they got probation, the law allows the nursing homes to keep hiring them.

That means a nurse aide can commit a serious or violent crime, gain deferred adjudication, and successfully fulfill the terms of their probation, to avoid a “final conviction.” The individual, though often pleading guilty to a serious or violent crime to gain probation, remains eligible to be a CNA.

This can be very dangerous to any resident but especially those with dementia.  At minimum wage, a nurse aide must clean, bathe and feed as many as 30 residents at a time. That’s compounded by Texas’ lack of minimum staffing level requirements.

They have dementia, Alzheimer’s, symptoms that cause them to have a lack of communication,” said Ernest Tosh, an attorney who handles nursing home abuse cases across the United States.

They can’t express exactly what happened, which is why violent offenders should be screened out from working in these facilities,” Tosh said. “They can physically or sexually assault an individual and there be no repercussions because that individual can’t identify them or communicate what happened.”

I think our state needs to recognize that nursing homes are not as poor as they claim to be,” said J.T. Borah, an attorney who specializes in nursing home abuse and neglect. “If the industry were to finance and staff at the level they were supposed to, they could afford better employees. They could have better applicants.”

 

The Age published an article on recent deaths caused by untreated flu.  The fatal flu outbreak at St John’s Village nursing home caused the death of 10 residents and two others from respiratory illness.  The government investigation blames serious management failures–it took days after infections began in August for management to report the outbreak.  By the time they did, 16 residents and eight staff were already sick.

In response, the St John’s Village nursing home accepted the resignation of its own former acting care services manager and referred him to his professional body for potential sanction.

Politico reported that many insurers in the Affordable Care Act market are on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate markets in their states.  The POLITICO analysis shows that insurers, on average, spent 78 percent of premium revenues on customers’ medical claims through the first nine months of this year.

“The political narrative is over a market in crisis, and that’s just not how the market actually looks right now,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonpartisan research group. “At this moment, the individual insurance market looks quite stable and most insurers have achieved profitability.”

However, Trump’s reckless decision to cut off subsidy payments that insurers rely on to reduce the costs for low-income customers means plans will take a more than $1 billion financial hit, according to the National Association of Insurance Commissioners.

The Department of Justice announced four San Diego-area nursing homes owned by Los Angeles-based Brius Management Co. have agreed to pay at least $6.9 million to resolve allegations that their employees paid kickbacks for patient referrals and submitted fraudulent bills to government health care programs. The four nursing homes involved in the settlement are: Point Loma Convalescent Hospital, Brighton Place – San Diego, Brighton Place – Spring Valley, and Amaya Springs Health Care Center in Spring Valley.  The settlement resolves an investigation into allegations that their employees paid kickbacks to discharge planners at Scripps Mercy Hospital San Diego to induce patient referrals to the nursing homes in violation of the federal Anti-Kickback Statute.

“Kickbacks for patient referrals are illegal under federal law because of the corrupting influence on our nation’s healthcare system,” said Acting United States Attorney Sandra R. Brown. “This settlement demonstrates our resolve to combat fraud that compromises the care provided to patients served by a government healthcare plan. This case further shows the power of whistleblowers to shine a light on corrupt activities and obtain significant recoveries on behalf of United States taxpayers.”

The investigation examined additional allegations made in a “whistleblower” lawsuit that the nursing homes submitted false claims to Medicare and Medi-Cal for services provided to patients referred from Scripps Mercy Hospital. Bills submitted for patients referred as a result of illegal kickbacks would constitute fraud against the United States and the State of California.

The settlement resolves a lawsuit brought by a former employee of one of the nursing homes under the qui tam – or whistleblower – provisions of the federal and state False Claims Acts, which allow private citizens to file lawsuits on behalf of the United States and California and share in any recovery. The whistleblower, Viki Bell-Manako, will receive 20 percent of each settlement payment. Pursuant to the settlement, United States District Judge John F. Walter today dismissed the lawsuit, United States of America, State of California ex rel. Bell-Manako v. Brius Management Co., et al., CV11-2036-JFW.

Nursing home employees conspired to pay kickbacks allegedly without the knowledge of Brius Management Co. The nursing homes admitted that their employees used corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a cruise on the Inspiration Hornblower that were given to planners at Scripps Mercy Hospital as kickbacks.

“Skilled nursing facilities that pay kickbacks in order to boost profits will be held accountable for their improper conduct,” said Christian J. Schrank, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General. “We will continue to crack down on kickback arrangements, which can corrupt medical decision-making and undermine the public’s trust in the health care system.”

 

 

The Buzz had a peculiar story about Rick Scott’s attempt to hide and cover-up the neglect and abuse in Florida’s nursing homes.  Recently, with no announcement or notice, AHCA wiped its website clean of all nursing home inspections, shielding the industry to the detriment of consumers.

For many years, Florida’s Agency for Health Care Administration’s website included links to inspections of nursing homes, retirement homes and hospitals. They were available with a few keystrokes with very few redactions. The agency then began to heavily redact the reports — eliminating words such as “room” and “CPR” and “bruises” and “pain” — and rendering the inspections difficult to interpret for families trying to gauge whether a facility is suitable for a loved one.  AHCA says the redactions were necessary to protect medical privacy, though patients were identified only by number.

In the past year, the state spent $22,000 for redaction software that automatically blacks out words the agency says must be shielded from the public. Those same words were available on a federal website unredacted. Elder and open-government advocates said the newly censored detail did more to protect the homes than patients.

 

 

 

The Clarion Ledger reported the settlement between the Department of Justice and a Georgia nursing home and its management company for “grossly substandard care”.  Hyperion Foundation, the owner, and AltaCare Corp., the management company, agreed to pay $1.25 million to resolve allegations of Medicare and Medicaid fraud for failing to provide care at Oxford Health and Rehabilitation nursing home.

The poor quality and lack of staff caused serious health issues including pressure ulcers, dehydration, malnutrition, and falls according to the government investigation.  I hope the DOJ continues to investigate the adequacy of the services provided to nursing home residents to increase quality and to rid the industry of the waste, fraud, and abuse that is so common.

 

 

 

CBS12 Investigates uncovered reports of true horror stories happening at nursing homes across the country that should have been reported to law enforcement.  These cases include life threatening falls, starvation, even sexual assaults that were not reported.

 “We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.

“CMS acknowledged that that they are not doing the data match to identify cases of neglect,” added Roy. “They also acknowledged that they have not identified any instances of nursing home staff not reporting cases as required.”

The audit found 38 cases that were so bad, by law the nursing homes were required to contact local law enforcement. But, they didn’t do it.

CMS must initiate protocols to adhere to a long-standing federal statute that requires nursing homes to report abuse cases to police and other state agencies immediately or risk fines of up to $300,000.

“They don’t care about those fines,” explained attorney Joe Landy. “It is business as usual. It is cheaper to pay those fines to keep these facilities understaffed with people that are not properly trained while they make record setting profits.  “It exposed what is a long-standing problem in Florida,” said Landy. “It exposed a nursing home that was making a huge amount of money with no accountability whatsoever.”

WFLA had an article about the horrific neglect and abuse suffered by Willie Johnson at the hands of the caregivers at Habana Health Care Center owned and operated by Consulate Health Care. His daughter Tonya Baker said her elderly father is living in poor conditions and shared photos to prove it.  “Not taking care of my dad, not feeding my dad, going in there finding my dad, wet Pampers, Depends, not being changed,” she said.

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“My daddy’s not getting the care that he’s paying for to stay in that facility,” Baker told me.  Baker has filed five complaints with the State’s Agency for Health Care Administration about the nursing home. Four out of five times, they found the nursing home violated its own rules or law. But despite the state’s involvement, Baker says problems persist.

“I also went in there and had them take my daddy’s air conditioning out the wall because he had a lot of mold in there, in the air conditioner and in the air conditioner wall,” explained Baker.

The photos include one where he has a busted lip. Baker said the facility told her he was punched by a roommate. Another photo shows her father with a gash on his forehead after a fall in the shower.

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News Channel 20 had an article detailing the problem in Illinois nursing homes but it applies to most other states too.  The most recent audit by the Inspector General’s Office of Health and Human Services says Illinois has the highest number of nursing home neglect incidents in the U.S.  Unfortunately, at least 40 percent of these incidents go unreported to local authorities.

 

Newsweek reported that enrollment for health insurance under ObamaCare is healthy with less than a month to go in the current sign-up period, according to the Centers for Medicare & Medicaid Services, a federal agency.  That brings the total number of enrollees in this period to 2.3 million, which is almost 900,000 people — or 64 percent — more than the number of customers who signed up during the first four weeks of enrollment in 2016, according to CNBC.  The figures included more than 566,000 new consumers and 1.7 million renewals, with total Healthcare.gov users exceeding 8.1 million.

The current enrollment period ends December 15.  Americans have much less time to sign up than in the past.  The Trump administration is deliberately making the HealthCare.gov portal unavailable at key times to discourage participation.