The New York Times had an interesting article about the soaring salaries fo medical specialists.  "Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones."

"Doctors’ charges — and the incentives they reflect — are a major factor in the nation’s $2.7 trillion medical bill. Payments to doctors in the United States, who make far more than their counterparts in other developed countries, account for 20 percent of American health care expenses, second only to hospital costs."

"The same specialties tend to appear at the top of physician earners: orthopedics, cardiology, anesthesiology, radiology, dermatology, plastic surgery, urology, gastroenterology and ophthalmology. Physicians in those fields typically earn more than $350,000 annually, according to American Medical Group Association, a trade organization. In many specialties, income has risen more than 10 percent since 2011, according to Medscape, a Web company that follows the industry."

More than 750 lobbyists represent groups of health professionals in Washington, pushing back on any effort to limit their incomes. The biggest spenders on lobbying — $80 million annually by health professionals — closely align with the highest-paid specialties.

The Washington Post had an article on Washington D.C.’s Office on Aging launch of its Nursing Home Transition Program which allows people to avoid nursing homes and receive in-home care instead.  This approach is a stark change from the past, when institutionalization was the preferred solution for those who needed help with day-to-day living. Those who qualify for Medicaid can receive Medicaid-funded services at home; for those who don’t, the Office on Aging helps find other funding for in-home care. The office also offers nonmedical help such as transportation, meals, and homemaker services to all District residents 60 and older, regardless of income, in accordance with the federal Older Americans Act.

"The program reflects a trend nationwide toward providing older and disabled people with in-home care rather than keeping them in nursing homes. To encourage this shift, the 2010 Affordable Care Act makes Medicaid benefits more broadly available to people living at home and increases federal funding to states that make more home care services available to those who would otherwise be in nursing homes. So far, 17 states, including Maryland, have been approved for additional funding."

A major reason for the change is the high cost and inadequate care of institutional care. As the population of older Americans grows, advocates say, it won’t be economically sustainable to have so many live in nursing homes. The average annual cost per person for nursing home care is about $75,000 nationwide. In the District, it is $110,000. Providing in-home services costs an estimated $30,000 to $60,000 a year, according to the city’s Office on Aging.

"The District program serves people who are ineligible for a federal Medicaid program called Money Follows the Person, which also helps older people and those with disabilities return to their communities from nursing homes, but has requirements such as that a person must have been in a nursing home or hospital for at least 90 days and must have received Medicaid in the last month of services there."

 

Yolanda Blount, aka Yolanda King, of Macon, Georgia was sentenced to serve 324 months (27 years) imprisonment in a case of wire fraud, mail fraud, conspiracy, theft of public money, aggravated identity theft and access device fraud.  The Court also ordered Ms. Blount to pay restitution to the Internal Revenue Service in the amount of $493,507. Ms. Blount entered a plea of guilty to the charges on September 4, 2013.  In her plea agreement, the defendant admitted that beginning in 2010, she obtained stolen identities of nursing home patients and used that information to file fraudulent income tax returns. Some federal tax refunds were processed in the names of the patients and mailed to Ms. Blount’s address. Others were directly deposited into a bank account belonging to the defendant.

Blount demanded refund claims against the Government in the amount of $511,951.00. From those claims, the Internal Revenue Service actually paid out $460,692 in false claims. The total amount of actual loss to the United Sates, including the nursing home patient refunds and the Capital City Bank refunds, was $493,506.60. The total amount of fraudulent refund claims is $550,151.

 

 

Republican News Watch had an interesting article written by Doug Ibendahl (former General Counsel of the Illinois Republican Party) on Republican gubernatorial candidate Bruce Rauner.  Rauner has a history of shady business deals resulting in multiple lawsuits involving Rauner’s former private equity firm.  

 

 

"In 2000 The Wall Street Journal said: “The vultures are circling the carnage in the nursing-home industry. With some of the largest nursing-home operators under bankruptcy protection and others heading in that direction, a number of deep-pocketed investors are preparing to swoop in on the choice morsels.”"   Bruce Rauner’s Chicago-based investment firm GTCR, LLC (formerly known as GTCR Golder Rauner) decided to get in on the action and one vehicle it used was Trans Healthcare Inc. (“THI”). THI’s launch to acquire nursing homes appealed to GTCR “because a new prospective payment system for Medicare was just being implemented,” said Ned Jannotta Jr., then a GTCR principal."

 

 

Rauner was with GTCR for three decades. He left the firm in October 2012 in advance of his run for governor.  According to court documents, many elderly residents of those nursing homes paid the ultimate price. The article gives a few examples but others are well known in the industry. 

" A jury in Polk County, Florida, returned a $1.1 billion verdict last month in a case involving what was described as “corporate corruption” and “misconduct” that ultimately led to the death of a nursing home resident. The jury agreed that defendant, Trans Health Care, Inc. (THI), deserved to be punished for such severe corporate greed that it caused Ms. Arlene Townsend to suffer for years in a nursing home that was short-staffed and under-supplied. The jury awarded $110 million in compensatory damages and $1 billion in punitive damages."

 

The Plaintiff’s lawyers presented evidence showing how Ms. Townsend was the victim of a scheme by an enterprise that included: New York real estate investors including Rubin Schron and Murray Forman; financiers General Electric Capital Corporation (GECC) (a private bank) and Ventas, Inc. (a real estate investment firm); and multi-billion dollar Chicago private equity fund GTCR Golder Rauner, LLC.   According to trial testimony, this group conspired to run a nursing home chain into insolvency without regard to the harm the nursing home residents would experience.

 

"An expert forensic accountant testified that GTCR founded THI in 1998 with a plan to create the largest privately owned nursing home company in the country through a series of mergers and acquisitions. Their Boards of Directors were composed solely of investors and bankers, and did not include a single health care official. From 1999 to 2003, GTCR and THI began acquiring nursing homes with funding from GECC, Ventas and other lenders. THI became one of the nation’s largest health care operators with more than 220 facilities and more than a billion in revenue at that time."

 

When Medicare money for residents’ rent flowed into the THI account, GECC and Ventas took their share before monies were available to cover payroll, supplies, utilities, etc. for the hundreds of nursing homes, according to evidence presented at trial.  Insider operators and former employees began suing GTCR/THI over poor management, as did nursing home residents and their families because of what was described as abysmal care.

Eventually, to protect itself from financial loss, GTCR/THI agreed to sell THMI for a mere $100,000 to Fundamental Long Term Care, Inc. (FLTCI), a shell company that had no employees.  On November 13, 2013, a U.S. Bankruptcy Judge for the U.S. Bankruptcy Court, Middle District of Florida, Tampa Division, notes “[a]s of now, the targets are defendants to fraudulent transfer and alter ego claims asserted by the creditors in this Court.” The case is In re Fundamental Long Term Care, Inc., Debtor, Case No. 8:11-bk-22258-MGW, Chapter 7.   “Targets” include General Electric Capital Corporation; Fundamental Administrative Service, LLC; THI of Baltimore, Inc.; Fundamental Long Term Care Holdings, LLC; Murray Forman; Leonard Grunstein; Rubin Schron; Ventas, Inc.; GTCR Golder Rauner, LLC; GTCR Fund VI, LP; GTCR Partners VI, LP; GTCR VI Executive Fund, LP; GTCR Associates, VI; Edgar D. Jannotta, Jr.; and THI Holdings, LLC.

 

 

 

 

 

 

Legislators in Florida are proposing a new bill that could make nursing homes more accountable for their actions. The bill in question would force nursing homes placed on the Agency for Health Care Administration’s watch list to post notices at all entrances and notify the families of all patients detailing the reasons they are on the list. Facilities on the watch list normally have a record of neglect, health and safety violations, inappropriate supervision, and financial mismanagement. Of the 662 licensed nursing homes in Florida, 139 are on the list. Penalties may be issued by the AHCA for failure to provide notice. No final decision has been made on the bill as of yet.   See article at WCTV.

In 2012, 17% of hospice patients died in a nursing home, a slight decrease from the 18% of 2011. The National Hospice and Palliative Care Organization compiled a report on hospice deaths in nursing homes. Their report cautions that because of lifespans lengthening and chronic diseases becoming more prevalent, hospice care in nursing homes will become much more common than it is now. It will have to. For more information, and to read the report, check out the McKnight’s article here.

Cassandra Bailey was arrested in November 2013 for stealing money from patient funds and the St. Andrew’s Place budget. She was the business office manager who received an Employee of the Month award. The home is refunding residents who had money stolen from their accounts, but the actual amount Bailey took is still unknown. Police arrested Bailey at her mother’s house, where, according to the authorities, she was hiding. Bailey’s bond is set at $50,000.  See full article at KATV.
 

In New York, a terrifying incident occurred at the Cambridge Guest Home for Retired Adults. One resident woke up in the middle of the night needing assistance.  She hit the call bell, yelled out, but no one responded.  To get help, the resident had to pull the emrgency fire alarm which woke and scared all the residents.

While emergency responders finally arrived, no employees came forth to help the residents. Only upon the police’s arrival, after an hour of searching, was an employee found. One female attendant was sleeping in the rec room, most likely under the influence of sleeping pills that police found in her bag.  It is believed at this time that the employee was the only one responsible for the home that night. The employee was immediately fired, and authorities are moving forward with endangerment charges against the former employee.  Why was she the only employee there?

 See Fox article here.

Four caregivers at the Hillcrest Nursing Home in Lancaster, UK have been charged with mocking, bullying and physically assaulting patients, reportedly for their own amusement. The caregivers targeted eight patients with severe dementia, because they believed they would have no memory of their abuse. However, many patients were able to remember traces of the events and exhibited extreme distress when the actions took place.  See Daily Mail article.

Perhaps the worst offense was the repeated taunting and physical abuse with balls and beanbags. These items were supposed to be used for physical therapy, but were thrown at patients heads and at speeds entirely too fast for patients to catch. This frustrated and angered the patients, but only created laughter amongst caregivers. Other offenses include the stomping of feet, being dumped out of a wheelchair, the pulling of loose skin and even slaps across the face. In one incident an elderly man’s nipples were twisted and repeatedly flicked, resulting in harsh bruises. Any objections or signs of distress by the patients were met with even harsher treatment and continued abuse.

Despite their severe dementia, some patients would remember their abusers. One man refused to be put in the same hallway as his abuser after she was caught in bed with him and clung to his door frame when being wheeled out. Other patients were not as lucky, as the caregivers would repeatedly target patients with the most acute dementia and would target particular individuals. The continued abuse left lasting marks on the patients, both physically and mentally and continued for an alleged seventeen months.

One senior caregiver has already admitted to eight counts of ill treatment and negligence under the Mental Capacity Act that governs patients with dementia. The other three have denied their claims. Together, the four caregivers total twenty one offenses under the Mental Capacity Act and trial still continues for the three that denied the claims against them. Charges were made only after three contacts to the Care Quality Commission by a local whistle blower. Clearly, there is a problem with the regulation of these nursing homes and cases such as these could be occurring without notice. The fact that four nursing home ‘caregivers’ were able to get away with this amount of abuse is appalling, especially considering these patients could not properly express their anger and pain.
 

Remarks attributed to Associate Justice Donald W. Beatty of the Supreme Court of South Carolina have led to a recent public discussion over whether Justice Beatty should refuse to hear certain cases based not on the facts of the individual case in question, but on the category of cases before the Court.  As you may or may not know, Justice Beatty used a recent speaking invitation to remind the prosecutors in this state that their duty is to seek truth and justice, not to win convictions.  In turn, several solicitors have suggested that Justice Beatty should automatically recuse himself from hearing appeals in criminal cases or cases involving disciplinary complaints against prosecutors. 

For many reasons, we believe such a broad-based request for Justice Beatty’s recusal is not only unwarranted, but also improper under our system.   We are a group of current and past presidents of an organization now called the South Carolina Association for Justice and formerly known as the South Carolina Trial Lawyers Association.  We are writing here, however, as individual lawyers who represent South Carolina citizens before the trial and appellate courts of this state in all types of cases.

The cornerstone of justice in South Carolina is the independence of the State’s judiciary.  Having faith in the rule of law requires us to believe in the integrity and independence of the court system.  A large part of the integrity and independence of judges depends in turn upon those judges acting without fear or favor.  This notion is recognized by the rules that govern the conduct of South Carolina judges (specifically Canon 1 of the rules and its Commentary), and we submit that it is also a function of common sense.  For the court system to work, a judge must be and feel faithful to the law and not be swayed by partisan interests, public clamor, or fear of criticism.  Beyond this duty, however, judges and justices have an obligation to decide the cases that are presented to them.  Put differently, judges are obligated to not recuse themselves unnecessarily.  You might say it this way – judges have just as much of an obligation not to step down from a case when there is no reason to do so as they have to step aside when there is a legitimate reason to do so. 

We know Justice Beatty and, like every other member of the Supreme Court, he is a person of unquestionable integrity and complete fairness.  These traits are reflected in everything Justice Beatty has ever done in his life, including the decisions he has made while a judge on the circuit court and the Court of Appeals and while a member of the Supreme Court.  In our view, the remarks attributed to Justice Beatty do not reflect the words of someone who has a predisposition as to a particular case or category of cases.  Rather, those words, if true, reflect Justice Beatty’s commitment to adhere to the law as set forth by the South Carolina General Assembly as well as the rules governing judicial conduct.

In South Carolina, we are fortunate to have many good prosecutors who are dedicated to seeking justice.  We are also fortunate to have good people serve in our judiciary who strive to carry out their roles in our system of justice in a manner that invokes confidence by our citizens.  Justice Beatty is among the best of those who have served this state, and his past decisions represent an unbroken record of adherence to the law and decisions based upon the specific facts of each individual case.  We believe that the remarks attributed to him do not sway from the path of justice that he has followed throughout his career, and we firmly believe the people of South Carolina can be confident that he will continue to decide each case on its facts and apply the law fairly and justly.

Rodney C. Jernigan, Jr., Matthew T. Richardson, John S. Nichols, D. Kenneth Baker, Mark D. Ball, Luther J. Battiste, III, Mark D. Chappell, John E. Duncan, Gerald M. Finkel, O. Fayrell Furr, Jr., E. Paul Gibson, Charles L. Henshaw, Jr., S. Randall Hood, Mark C. Joye, Ellis I. Kahn, Steven M. Krause, Ronald A. Maxwell, S. Kirk Morgan, Jr., Preston F. McDaniel, William H. Nicholson, III, Douglas F. Patrick, A. Hoyt Rowell, III, Kenneth M. Suggs, Tom Turnipseed, Kathryn Williams