The West Virginia Record had an article recently about the lawsuit against another Sava Senior Care facility owned and operated by Murray Forman and Leonard Grunstein and others.  Defendants include six companies, an individual and multiple unknown individuals and entities for negligence in a nursing home. Canyon Sudar Partners, SVCare Holdings, Sava Senior Care, SSC Equity Holdings, SMV Management Company, SMV Huntington and Unidentified Entities 1 through 10 are the companies named in the law suit. Huntington Health and Rehabilitation Administrator, Annica Stansberry, and John Does 1 through 10 were also named in the suit.

Faith Cole claims Ruth Haynie was a resident of Huntington Health and Rehabilitation from Sept. 20 until Nov. 1, according to a complaint filed Feb. 25 in Cabell Circuit Court. Cole claims the defendants were aware of Haynie’s medical condition and the care she required, but that during her stay, Haynie experienced falls, a fracture and a subdural hematoma.

Cole claims the defendants owed a duty to residents to exercise reasonable care in providing oversight and management of the nursing home.

The defendants breached their duty by failing to properly manage, operate and/or control the nursing home in a manner that a reasonably careful person/corporation would have provided.

Cole is seeking compensatory damages. She is being represented by James B. McHugh and Michael J. Fuller Jr.

 

President Barack Obama will bring in high-tech bounty hunters to help root out health care fraud, grabbing a populist idea with bipartisan backing in his final push to overhaul the system. The White House released details of the anti-fraud plan.  Obama’s anti-fraud announcement was aimed directly at the political middle.

Waste and fraud are pervasive problems for Medicare and Medicaid, the giant government health insurance programs for seniors and low-income people. Improper payments – in the wrong amounts, to the wrong person or for the wrong reason – totaled an estimated $54 billion in 2009. They range from simple errors such as duplicate billing to elaborate schemes operated by fraudsters peddling everything from wheelchairs to hospice care.

The bounty hunters in this case would be private auditors armed with sophisticated computer programs to scan Medicare and Medicaid billing data for patterns of bogus claims. The auditors would get to keep part of any funds they recover for the government. The White House said a pilot program run by Medicare in California, New York and Texas recouped $900 million for taxpayers from 2005-2008.

The presidential memorandum Obama signed directs Cabinet secretaries and agency heads throughout the government to intensify their use of private auditors under current legal authority. Obama also announced his support for a bipartisan bill that would expand the ways government agencies can pay for such audits using recovered funds. Among its co-sponsors is Sen. John McCain, R-Ariz., Obama’s GOP opponent in the 2008 presidential race.

The White House estimates that expanded use of private audits throughout the government could recoup at least $2 billion for taxpayers over the next three years. Much of that would come from Medicare and Medicaid, which have to scramble to keep up with the endless proliferation of new fraud schemes.

Obama his placing a heavy emphasis on battling waste and fraud in his final health care push. The repackaged bill he announced last month contained more than dozen anti-fraud ideas. A common theme linking them is the increased use of technology to spot suspicious billing patterns and keep track of service providers with a track record of problems.

 

Becker’s ASC Review had an article about a three-week trial where a Detroit federal jury convicted Jose Castro-Ramirez, MD on 13 counts in connection with an $18.3 million Medicare fraud scheme.  Dr. Castro-Ramirez was convicted of one count of conspiracy to commit healthcare fraud, 11 counts of healthcare fraud and one count of conspiracy to launder the proceeds of the fraudulent scheme.

Beginning in 2003, the Detroit area physician entered into an agreement with Suresh Chand, a co-conspirator and owner of several companies based in Warren, Mich., that purportedly provided physical and occupational therapy services to Medicare beneficiaries.  In reality, Mr. Chand and his associates created false therapy files documenting physical and occupational therapy services to Medicare beneficiaries that had not occurred. The fictitious services were then billed to Medicare through fake providers controlled by Mr. Chand.

Mr. Chand and others paid kickbacks and provided other inducements to Medicare beneficiaries in exchange for their Medicare numbers and signatures showing they had received therapy services. Dr. Castro-Ramirez signed therapy prescriptions falsely indicating that he had evaluated the Medicare beneficiaries and recommended the therapy, when in fact, he had not overseen any treatment to the patients and was aware that he was participating in fraud.

Dr. Castro-Ramirez also wrote thousands of prescriptions for controlled substances including Vicodin and Xanax for patients he had never seen between 2003 and 2007, as part of Mr. Chand’s recruitment of the Medicare beneficiaries.

Dr. Castro-Ramirez profited from the scheme by receiving proceeds from billings to Medicare for "home visits," many of which were never made, for beneficiaries Mr. Chand recruited. Mr. Chand also distributed proceeds directly to Dr. Castro-Ramirez through transactions intended to hide the origins and nature of the funds. Dr. Castsro-Ramirez submitted $1.4 million in claims to Medicare for the "home visits," $929,000 of which Medicare paid. Mr. Chand and his co-conspirators submitted claims to Medicare totaling $18.3 million for therapy services that were supposedly overseen by Dr. Castro-Ramirez but were never performed. Of these, Medicare paid $8.56 million.

Mr. Chand pleaded guilty in Sept. 2009 in U.S. District Court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to launder money.

At a scheduled June sentencing, Dr. Castro-Ramirez faces a maximum penalty of 10 years in prison and a $250,000 fine for the healthcare fraud conspiracy and fraud counts, as well as a maximum penalty of 20 years in prison and a $250,000 fine on the money laundering conspiracy count.

 

There was an interesting article in The Telegraph about the jury trial involving the wrongful death of Gerald Flannary.  The case involved claims that personnel at Rosewood Care Center in Edwardsville failed to inform the patient’s doctor that he had developed a painful ulcer on his heel.

Attorney Robert Gregory told the jury in Madison County Circuit Court that his client is not claiming damages for causing the ulcer but for failing to report it to the doctor in a timely manner and lack of proper treatment.

Gregory is asking for damages for the added cost of treatment, the emotional effects on the family, the pain and suffering caused to the patient and loss of a normal life. The added cost of treatment is estimated at about $34,000. The loss of normal life means loss of what would be normal for a man living in a nursing home, Gregory pointed out.

He noted that Flannary could walk when he was admitted on Dec. 4, 2003, but did not walk after that.  A deposition in the case showed that Flannary suffered from a number of medical problems, including Alzhemier’s disease.

A doctor, testifying in a deposition in the case, said the ulcer caused tissue damage down to the bone and would have been painful.

Gregory told the jury in closing arguments that Martha Flannary, Gerald Flannary’s wife, contacted the Illinois Department of Public Health about the case, and that agency issued a violation. Rosewood did not appeal but offered a plan of correction, he said.

He noted that nurses who testified in the case said they could not recall talking to IDPH.

Of course, the defense made the trial about the plaintiff’s lawyer, Flannery’s pre-exisitng conditions (which all nursing home residents have!), and the honor and compassion of nurses in general instead of the clear violation of the standard of care. 

The nursing home’s lawyer provided by the insurance company argued that Gregory was honing in on a "small detail", when the "big picture" showed that the nurses and other staff members allegedly made a detailed record of Flannary’s overall condition.

"This case is supposed to be all about a lack of communication. Only a trial lawyer would say that 316 pages of medical records amounts to a lack of communication," McCubbin said.  Of course, McCubbin is a trial lawyer too.  Gregory took exception to McCubbin’s repeated reference to the plaintiff’s attorney as a "trial lawyer," as if to take advantage of some of the negative publicity trial lawyers have received. Gregory noted that his opponent also is a lawyer and was arguing a case in a trial. He wondered how McCubbin would describe himself. "I guess you would describe him as a corporate lawyer," Gregory said.

"His motive is money. He wants to gloss over the big picture," McCubbin said about Gregory.  Of course, defense lawyers represent clients for money too.  I never saw any defense lawyer take a case pro bono.

McCubbin also argued that staff members at Rosewood work 365 days a year caring for patients such as Flannary. He said they are dedicated to their work and to their patients. He said some of them testified that their patients "were like family members."  Many nursing home employees are great, many are not.

McCubbin argued that Flannary had a history of ulcers and blisters before and after he was admitted to Rosewood.  Those ulcers healed properly because the doctor was informed of them.

He called the investigation into the case "sloppy" because it missed some of the details available in the records.  This is a typical defense tactic.  When the investigation substantiates the abuse or neglect, they disparage the investigation.  When the investigation supports the facility, the defense lawyers praise the investigatory abilities of the State regulators.

9News.com had an article about another sexual assault at a nursing home.  Nursing homes need to do a better job of screening applicants and supervising their employees. Police arrested Gabriel Paul Cabral, a 41-year-old assisted living facility employee, for allegedly having sex with a woman in her late 80’s.  He’s been charged with crimes against an at risk adult.

Investigators went to the assisted living facility after the family of the victim indicated they had video of the caregiver having sex with the woman.  Police say the family installed a hidden camera in the victim’s room in late December.  Investigators say the family became suspicious that the woman was being mistreated.   Police say Cabral has worked at more than one assisted living facility in the area.

 

 

Robert Gunderson was sentenced to a decade of probation for sexually abusing an elderly patient at the nursing home where he worked as an aide.  He could have faced up to seven years on charges brought against him by the state attorney general’s office. His sentence was part of a deal that saw him plead guilty to attempted first-degree sexual abuse.

The attorney general’s office said Gundersen fondled a physically helpless 78-year-old woman at the Northwoods Rehabilitation Center and Extended Care Facility.  He worked there as a nurse’s aide at the time. In court in January of this year, he admitted to touching her breast.

Gundersen must register as a sex offender and is prohibited from working at a health care facility in the future.

The attorney general’s office still has a charge of third-degree sexual abuse pending against Gundersen for an alleged incident that occurred while he worked at the Eddy Ford Nursing Home in Cohoes. In that case, which is still pending in Albany County, he is accused of French-kissing a wheelchair-bound patient with multiple sclerosis in August and September of 2008.