The Nursing Home Complaint Center says, "We believe needless sepsis infections, septic shock translates into wrongful deaths in our nation’s nursing homes, its a gigantic problem, and we want to hear from family members who can prove the sick, or deceased family member was mistreated, or not treated at all-with the net result being a wrongful death caused by sepsis, or they are now in a ICU at a hospital in septic shock." The group says, "Sepsis, or septic shock should almost never happen. One of the biggest problems we see in the vast majority of our nation’s nursing homes is staffing levels, are not high enough to meet the needs of the patients, with the net result being dead patients, or patients suffering from sepsis, or septic shock, due to lack of care for the patient."

The Nursing Home Complaint Center says,"Short staffing at a nursing home not only bilks the taxpayer for services never rendered, it also kills patients. If an employee of a nursing home possesses very specific, and verifiable information about fraud, please contact the Nursing Home Complaint Center.

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The nursing home continues to profit despite their complaints about adjustments in reimbursements from Medicare and Medicaid.  Kindred Healthcare’s RehabCare contract therapy division is holding steady.  Kindred reported overall consolidated revenues up by 1% to $1.5 billion and operating income at close to $200 million. The company acquired RehabCare in June 2011.  Kindred’s hospital division revenues grew 4%, and the company continues to dig into home health and hospice, with its recent IntegraCare acquisition adding $71 million in annual revenue. 

Skilled Healthcare reported revenue of $216.6 million, beating expectations. Ventas REIT also had a strong third quarter with net income up 8.7%. That was largely a result of $1.7 billion in acquisitions in 2012.

 

The Charleston Post and Courier reported the tragic but typical story of how an insurance company acted in bad faith and failed to protect their elderly insured.  "Mattie Jewel Poston thought her long-term care needs would be taken care of after her now deceased husband, Herman, took out a long-term care insurance policy with in Banker’s Life in 2003. Now in Heartland of West Ashley’s nursing home, Poston and her daughter, Kay Newman, were forced to battle Banker’s Life after the insurance company denied her claims."

"Despite extensive records showing that Mattie had Alzheimer’s and couldn’t care for herself, Banker’s Life denied Mattie’s long-term insurance claims for nearly a year. The dispute ended up in federal court and led to admissions from the insurer’s employees: In Mattie Poston’s time of need, the company failed to live up to its promise to pay to take care of her."

"Angry policyholders across the country have sued insurers for improperly delaying or denying claims; regulators have fined and ordered some to improve their claims handling procedures. Meanwhile, the state Department of Insurance has received more than 50 complaints about Banker’s Life since 2010."

 

CNN had an interesting article about one of the largest Medicare frauds in U.S. history.  "Dr. Alon Vainer, a medical director at dialysis clinics in Georgia, was discussing clinic procedures with one of the nurses, Daniel Barbir. The two men say they saw something they believed was very wrong: expensive medicine, and lots of it, was being tossed in the trash. And the clinic workers were being told to do it, the two men say."

"The alleged waste was being carried out on a massive scale and, the nurse and the doctor said, they knew why almost immediately. They claim it was a way for their company, DaVita Inc., to defraud the government, overbill Medicare and Medicaid and make a fortune."

"Vainer and Barbir said the alleged fraud schemes they discovered were going on at the company’s clinics all across the country — at the time, about 2003 through 2010, more than 1,800 — with tens of thousands of patients. It was enormous, they claim, and Vanier said it was all a deliberate strategy coordinated by the company."

DaVita Inc. is one of the nation’s largest dialysis companies. The company just moved into a brand new $101 million office tower, complete with fountains, gardens and even a suspended ski gondola inside for private meetings.  Most of DaVita’s revenue comes from a single source: taxpayers. More than two-thirds of DaVita’s revenue comes from Medicare and Medicaid payments.

DaVita settled a similar case in Texas for $55 million. Pat Burns, with the watchdog group "Taxpayers Against Fraud," says the bigger problem is that even if a company gets caught cheating the government, the company executives never seem to face any punishment. Fines are paid and business continues as usual.

 

Politico reported on new GAO Reports showing waste and fraud in Medicare and Medicaid programs.  Medicare needs better use data programmed into claims processing systems to stop fraud.  Medicare is estimated to have made $28.8 billion in improper payments in 2011, according to GAO. Medicaid was estimated to have made $21.9 billion in bad payments — a higher percentage of its outlays than Medicare’s bad payments because it is a smaller program.

The Department of Health and Human Services agreed with the assessments and said it’s in the process of strengthening the Medicaid anti-fraud efforts, in part to respond to the expected expansion of the program next year under health reform. On Medicare, GAO recommended that CMS strengthen the use of pre-payment edits, controls that are programmed into claims processing to screen for potentially fraudulent activity. GAO said Medicare needs to restructure some of the data and make it easier to use. HHS generally agreed.

 

 

Frank Gluck wrote an interesting article for USA Today about alarms as a means to prevent falls.  Obviously adequate staff and proper supervision are the best ways to prevent falls.  A new University of Florida study shows bed alarms, which were designed to alert medical staff when patients are getting up when they’re not supposed to, are not that effective especially if there is not enough staff to respond to the alarms.  "An 18-month review of nearly 28,000 patients, using 349 beds, at Tennessee Methodist Healthcare University Hospital found that the alarms did not translate into fewer falls."

"The study highlights a persistent problem for hospitals and the leading cause of injury and death for adults older than 65. U.S. emergency departments treat more than 2 million such injuries a year, according to the Centers for Disease Control and Prevention, at a cost of about $30 billion."

The problems include devices sounding off improperly, leading to "alarm fatigue," and alarms being ignored by overworked staff.  Studies show that falls are most likely to happen between 7 p.m. and 7 a.m. and are commonly the result of patients getting up to use the bathroom after call bells for assistance are ignored

 

 

 

 

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The L.A. Times reported a survey attempting to determine how many Americans derive a benefit from government programs.  A new study finds that 71% of Americans live in a household in which at least one member has benefited from one of the federal government’s major entitlement programs.  The new data shows the wide reach of the spending programs that make up a big part share of the federal budget.

More than half of Americans (55%) have personally benefited from one of the government’s six best-known entitlement programs including benefits from Social Security, Medicare, Medicaid, unemployment insurance, food stamps or welfare.  Rural residents disproportionately benefit, with 62% who live in rural areas having received entitlement payments of some variety, compared with 54% of urban or suburban residents.   If veterans benefits and federally subsidized college loans and grants are included, the share of Americans who have personally benefited rises to 70%, and the households that include at least one beneficiary rise to 86%, the survey found.

 

Justice Antonin Scalia in District of Columbia v. Heller (2008) wrote the following:

"Like most rights, the Second Amendment right is not unlimited. It is not a right to keep and carry any weapon whatsoever in any manner whatsoever and for whatever purpose: For example, concealed weapons prohibitions have been upheld under the Amendment or state analogues. The Court’s opinion should not be taken to cast doubt on longstanding prohibitions on the possession of firearms by felons and the mentally ill, or laws forbidding the carrying of firearms in sensitive places such as schools and government buildings, or laws imposing conditions and qualifications on the commercial sale of arms. Miller’s holding that the sorts of weapons protected are those “in common use at the time” finds support in the historical tradition of prohibiting the carrying of dangerous and unusual weapons. Pp. 54–56."

 

 

The Washington Post reported that a recent audit of Medicare reimbursements revealed billions of unverified spending for unspecified services.   Medicare has paid doctors, hospitals, and nursing homes over $4 billion since 2011 to switch from paper to electronic health records without verifying that the new systems meet required quality standards. 

"The report by the inspector general of the Department of Health and Human Services identified a range of ways that the program is vulnerable to fraud, and recommended that the Obama administration introduce stronger safeguards."