The Boston Herald reported the $2.2 million settlement to resolve allegations concerning inflated Medicare claims. Prosecutors say that Health Concepts and its COO, John Gage, failed to take sufficient steps to prevent Therapy Resources Management from fraudulently inflating the reported amounts of therapy provided to certain Medicare patients in Health Concepts facilities. Prosecutors say the facilities submitted bills for therapy that did not occur as reported.

Massachusetts U.S. Attorney Carmen Ortiz announced the agreement on Wednesday. It resolves allegations concerning rehabilitation therapy provided by Fall River, Massachusetts-based Therapy Resources Management at facilities in Rhode Island operated by Health Concepts, Ltd.


The Consumerist wrote an interesting article on the legal authority that allows CMS to prohibit mandatory arbitration clauses in nursing home admission agreements.

“We are requiring that facilities must not enter into an agreement for binding arbitration with a resident or their representative until after a dispute arises between the parties,” reads the rule. “Thus, we are prohibiting the use of pre-dispute binding arbitration agreements.”

When CMS proposed these limits in July 2015, industry insiders claimed that the agency lacks the authority to restrict the use of arbitration. However, CMS concluded that the Federal Arbitration Act (FAA), which allows for these sorts of clauses in contracts, does not limit regulators’ ability to put limits on the use of arbitration agreements.

[T]he plain language of the FAA applies only to existing arbitration agreements voluntarily made between private parties,” explains the CMS in the finalized rule, “it does not compel or require the use of arbitration between private parties. Because it does not prescribe circumstances in which arbitration agreements must be used, it does not impinge on federal agencies’ rights to issue regulations regulating the conditions of adoption of such agreements, assuming that the Secretary otherwise has proper statutory authority.”

However, because the CMS concedes that the FAA still applies to agreed-upon contracts, the new rule — which goes into effect Nov. 28, 2016 — will have “no legal effect on the enforceability of existing pre-dispute arbitration agreements.”

So if a nursing home resident has already signed a contract containing a mandatory arbitration clause, CMS confirms to Consumerist that the patient will continue to be bound by the terms of that agreement.

[T]he rule we are issuing does not affect already-existing arbitration clauses, but prohibits Medicare-and Medicaid-participating LTC facilities from using them in the future, as a condition of participating in these programs,” reads the rule (on p. 399). “While we share the same public policy concerns about already-existing arbitration agreements, we are only addressing agreements reached after the effective date of this rule.”

It is simply unacceptable to provide taxpayer dollars to organizations that deny consumers their day in court,” said Senator Patrick Leahy in a statement to Consumerist. “Today’s rule is a small but important victory in the long battle to root out these secretive, complicated arbitration clauses that favor corporate interests over consumer rights.”


The ultra-conservative National Review wrote a short piece on CMS’ new rule prohibiting nursing homes from forcing victims of neglect and abuse to waive their Constitutional right to a jury trial for confidential arbitration.

In the final rule overhauling skilled nursing facility federal regulations for the first time since 1991, CMS prohibits all arbitration agreements at the time of admission. According to CMS, such pre-dispute agreements are “fundamentally unfair” because “it is almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen.” Once a dispute arises, a facility and a resident may enter into a binding arbitration agreement so long as several requirements are met including voluntary participation by the resident/decision-maker and resident/decision-maker acknowledgment of understanding of the agreement after the facility fully explains it. For providers with existing pre-dispute arbitration agreements, those agreements will not be impacted by this final rule.

The arbitration portion of the final rule takes effect on November 28, 2016

WSPA reported on the new $41 million 108-bed facility to house honorably discharged vets, paying about $34 per day.  County leaders decided on a location, but aren’t revealing where the 35 acre property is going to be.  The state is building three new veterans nursing homes, including one in Cherokee County.  According to the United States Department of Veterans Affairs, a 2014 survey found more than 100,000 Vietnam War veterans in South Carolina.

“We need to do everything we can to make sure our veterans are taken care of,” said Cherokee County Veterans Service officer Todd Humphries.

The facility will come from federal and state funding. Humphries says it would also bring almost 200 jobs to the area.

“There will be doctors, nurses, dieticians – all sorts of medical staff and non-medical staff,” he said.

Once the federal dollars start rolling in, county officials hope to break ground as early as 2019.

Betsy Hammond of The Oregonian wrote an article about Stacy Molina.  Stacy was a certified nursing assistant at Healthcare at Foster Creek. She faithfully cared for a high-needs patient.  While she was sick with the flu, other Foster Creek employees failed to tend to a young male resident, and he developed a wound on his leg so deep that the bone was exposed.

Molina says in the suit that two co-workers took photographs of the wound, and one of them forwarded a copy of one photo to her. She in turn forwarded the photo, which contained no personally identifiable information, to a medical educator with whom she had previously discussed concerns about the young man’s care. She says she shared the photo with the educator in an effort to try to report and respond to what she believed was medical neglect.

Her supervisors asked her if she had shared the photograph, and when she said she had, they fired her for violating the patient’s medical privacy.  She believes it was for reporting that a patient had been seriously wounded by neglectful care.

Stacy believes that reason was a pretext and the real reason she was fired was for calling attention to the man’s grave wound. She said she has heard that the patient died shortly after she was fired.

Molina is asking for $75,000 in lost wages and benefits. She also wants a jury to award her  $500,000 in non-economic damages.  You can read her six–page lawsuit here.  The Elder Justice Act requires health care workers like Stacy to report suspected abuse, neglect, or financial exploitation.

Forbes wrote an article on new rules established by CMS for nursing homes that voluntarily accept federal and state taxpayer funding,  The last time CMS revised the regulations were 25 years ago.  A lot has changed since then.

The new regulations—all 700 pages worth—govern everything from staffing and dispute resolution to enhancing the role of residents and families in designing care.”

In recent years, it has become standard for nursing homes to require residents to agree at admission before any dispute arises to use confidential arbitration to resolve claims of neglect and abuse.  But industry arbitrators are biased; arbitration is too expensive for most residents; and the process is a way for facilities to keep major violations of health and safety rules private—since arbitration is confidential while litigation often is public

The new rules prohibit nursing homes from requiring residents to agree to arbitration at admission. However, once a dispute arises, the facility and the resident can still agree to use the process.

Grievances: Facilities are now required to set up a formal grievance policy that includes a written response to complaints by residents or their families.

Person-centered care. The new rules require facilities to give residents more control over care provided. They must support patient preferences including meals or hygiene. Residents and families must be involved in the process of writing a plan of care, which must be completed with 48 hours of admission.

Staffing: Unfortunately, the new rules do not require specific safe staffing levels for either aides or nurses.  The standard remains that the facility must provide the necessary staff in numbers and training to meet the needs of the residents. However, the rules do require more training for staff, contract workers, and volunteers. Training must include topics such as patient’s rights and better communication skills.

Discharge for non-payment: Facilities are barred from discharging residents if they have submitted paperwork to Medicaid and other payers but payments have not yet been made. In the past, some facilities would discharge residents if Medicaid was slow to pay. In addition, every notice of discharge must be sent to state ombudsmen, who can help residents and their families work through the issues before they are transferred.

Hospital dumping: The rules bar an especially egregious practice by some facilities. If a facility wants to discharge, say, a low-income patient whose care is not being reimbursed by Medicaid (perhaps because of those paperwork slowdowns), it will sometimes send the patient to the hospital, and then refuse to readmit her. This will no longer be allowed.


McKnight’s reported on the lawsuit that accuses SavaSeniorCare, one of the nation’s largest nursing facility operators, of overbilling Medicare for unnecessary therapy services.  Sava filed a motion to dismiss but a federal court has ruled the lawsuit can proceed.  The lawsuit, which consolidated three separate complaints against SavaSeniorCare LLC, alleges that the company pushed employees to provide high levels of therapy to residents or face “threats of repercussions or termination,” and be “publicly shamed” into meeting budget goals. The “unattainable” goals were enforced throughout Sava’s 185 facilities between 2008 and 2012, according to the lawsuit.

In his Sept. 27 opinion, Chief District Judge Kevin Sharp denied Sava’s move to have the case dismissed, citing “sufficient factual averments” to back up the claims of the former employees who brought the complaints against the provider.

A fair reading of the Consolidated Complaint suggests that [Sava], acting in concert, created and implemented policies in an effort to wrongfully enlarge Medicare billing,” Sharp wrote. “Given the scope of [Sava’s] request (dismissal of all claims), the brevity and wide sweep of their arguments, and their failure to acknowledge certain allegations, the Court finds it unnecessary to go any further.”

SavaSeniorCare ranks as the fifth-largest skilled nursing company in the United States, according to recent data, with 200 total facilities in 22 states.  The Order states the following:

B. Sava’s Structure and Operations

Sava is “organized in a pyramidal corporate structure.” (CC ¶ 54). Defendant SavaSeniorCare, LLC “sits atop” that structure, and, through its subsidiaries, owned and managed the operations of approximately 185 SNFs in 19 states (including Tennessee) during the relevant period. (CC ¶ 20). The remaining Defendants are (or were) wholly owned subsidiaries of SavaSeniorCare, LLC: (1) SavaSeniorCare Consulting, LLC provided consulting services and operational oversight to the SNFs, and employed most of the corporate-level rehabilitation and operations employees; (2) SavaSeniorCare Administrative Services, LLC performed certain “back-office” services for Sava’s SNFs, including submitting claims to Medicare, and employed Sava’s Chief Executive Officer (“CEO”), Chief Financial Officer (“CFO”), Senior Vice President (“SVP”) of Rehabilitation Services, and high-level finance employees; and (3) SSC Submaster Holdings, LLC provided services for the SNFs and employed many of Sava’s corporate-level rehabilitation and operations employees, some of whom later went to work for SavaSeniorCare Administrative Services and SavaSeniorCare Consulting when SSC Submaster Holdings ceased to exist in 2010.

Tony Oglesby “is at the top of Sava’s corporate structure,” serving as its CEO since 2005, and acquiring a majority ownership in Sava in October 2013. (CC ¶ 54).

Sava knew the financial benefits of increasing its Ultra High billings. SNF administrators, RPMs, and therapists were systematically pressured by corporate to meet targets for such billings and extend patient stays without regard to a patient’s actual needs. Beginning in 2008, if not earlier, Sava’s finance department set top-level goals – “budgets” – for the Company, that, in turn, trickled down to rehabilitation-specific goals at the divisional, regional and facility level. Thus, each of the SNFs was given set goals that were based on meeting pre-determined RU levels and Medicare Part A daily rates. Even though DVPs of Rehabilitation Services and RDRs could change the budget for a facility in their division or region, any changes had to be “budget neutral,” meaning that if an RU goal was reduced at one facility, it had to be increased at another.

Constant pressure was placed on both regional and facility-level employees to make their ever-increasing budgets. This pressure “was top-down, nationwide, and exerted by both rehabilitation and operations corporate-level employees.

The Globe Gazette reported the $900,000 verdict against Good Shepherd for the neglect of Maria Savas O’Brien. The jury, which deliberated for about 2½ hours on Friday afternoon and for more than six hours on Monday, determined Good Shepherd was negligent in its care of O’Brien.

The jury also determined the nursing home showed willful and wanton disregard for the rights and safety of another.

Savas O’Brien was at Good Shepherd for 2½ years. She was taken from Good Shepherd to the hospital in late March 2015 and died in early April 2015 at age 84 while in hospice care.

Expert witnesses for the family testified during the nine-day trial that a fall O’Brien had in March 2014 caused a downfall in her health and was preventable. Testimony also was presented alleging possible medication overdoses and staff failure to follow Savas O’Brien’s care plan, and mice in her room that left droppings on her bed, her bedside table and her religious icons.

She weighed 127 pounds when she entered the nursing home and lost 43 pounds while she was there.

O’Brien’s children will receive $150,000 in damages as compensation for her past physical and mental pain and suffering while she was at Good Shepherd. The family also is entitled to $750,000 in punitive damages, according to the jury.

O’Brien’s children — Kristine Christensen, Stephanie Prohaski, Anthony Savas and Theodore Savas —feel vindicated.

She said they did not file the lawsuit “to make a fortune” but to hold Good Shepherd accountable.

“Hopefully nursing homes will remember they are dealing with loved ones’ lives” and treat residents “the way they deserve to be treated,” Prohaski said.

The Alaska Dispatch News had an article on the new CMS rules banning mandatory pre-dispute arbitration in nursing home admission agreements.  “The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration.”

The sad reality is that today too many Americans must choose between forfeiting their legal rights and getting adequate medical care,” Sen. Patrick Leahy, D-Vt., said in a statement.

With its decision, the Centers for Medicare and Medicaid Services, an agency under Health and Human Services, has restored a fundamental right of millions of elderly Americans across the country: their day in court.

The Tennessean reported that Kathleen Graves, the owner of  Mabry Healthcare & Rehab Center, claimed more than $2 million in Medicaid expenses that were instead spent for personal use, including purchases at discount stores, restaurants, furniture stores, nail salons, personal travel and, in one instance, to help pay for the wedding of the owner’s daughter!  The Tennessee Bureau of Investigation is conducting a criminal investigation

Graves reported hundreds of thousands of dollars in expenses to care for patients on Medicaid, including $176,000 in gift cards, $134,000 in personal travel expenses and $81,000 in personal legal fees over a five year period, according to the audit.  Graves also claimed for reimbursement of $322,500 paid to a business run by her husband, $33,162 spent on her daughter’s college tuition and $1,184 for her daughter’s wedding.

Graves billed for children’s clothing, western wear, car washes, tickets to sporting and entertainment venues, Amazon and Paypal purchases and cellphones, the audit found.

Claiming such expenses artificially inflated the agency’s budget, allowing operators to bill Medicaid a higher rate for each patient, according to the Comptroller report.