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.

The Japan Times reported a good example of what happens when a nursing home is understaffed and the caregivers get burnt-out from being overworked.  Hisashi Minakawa, a caregiver at a Tokyo nursing home was arrested over the murder of an 83-year-old resident at the facility in August, the police said.  Minakawa admitted to the killing, the police said. The victim, Kan Fujisawa, “repeatedly wet the bed and I couldn’t stand it anymore,” Minakawa was quoted by the police as saying.   Fujisawa suffered Parkinson’s disease and could not control his bladder.

The killing took place in the early hours of Aug. 22. According to the police, Minakawa lost his temper after Fujisawa wet the bed multiple times the previous night. He strangled Fujisawa, threw him into a bathtub and drew hot water, according to the police.  Minakawa had been working a night shift with another worker on the night of the homicide but was alone with Fujisawa in the bathing facility.

Prior to his arrest he told the police he found the victim dead after he was away tending to an emergency call within the nursing home. But there was no record of such a call, according to the police.  The police launched the murder investigation after spotting evidence of strangling — a broken bone in Fujisawa’s throat.

The Sun Sentinel had a great article on new reforms to increase safety in Florida nursing homes.  A dozen bills to reform nursing homes are under consideration in the Florida Legislature after 14 people died at a Hollywood, Florida, nursing home that lost power during Hurricane Irma.  Many of the bills require nursing homes and assisted living facilities to have generators capable of powering air conditioning in the event of a power loss.

The latest give new teeth to Florida’s Long-Term Care Ombudsman program, which records show has regularly turned up fewer complaints each year under Gov. Rick Scott.  The Ombudsman program, which is supposed to look out for residents in Florida’s 683 nursing homes and thousands of assisted living facilities, would be allowed to conduct undercover operations inside nursing homes, posing as patients or employees, to look for abuse and neglect.

The big boost to the state Ombudsman program is unique among the many bills. Another novel portion requires facilities to allow residents’ families to monitor them electronically as a safeguard against abuse.

The multitude of other bills includes:

SB 284: Filed by state Sen. Lauren Book, D-Plantation, this bill requires nursing homes and assisted living facilities to have generators that can power air conditioning in the event of a loss of power, and requires the Agency for Health Care Administration to conduct an unannounced inspection at least every 15 months to check and make sure the generator is in working order. The bill requires facilities to have enough fuel to power generators for five days.

HB 479: Filed by state Rep. Patricia Williams, D-Lauderdale Lakes, this bill requires an unannounced inspection by AHCA every four months. It also requires nursing homes and assisted living facilities to have generators to power air conditioning and enough fuel to last for five days.

HB 327: Filed by state Rep. David Richardson, D-Miami Beach, this bill requires AHCA to carry out an announced inspection each May before hurricane season and requires facilities to have generators that can power air conditioning and enough fuel to last four days.

SB 372: Filed by state Sen. Rene Garcia, R-Hialeah, this bill would require generators to power air conditioning and enough fuel for four days. It also requires AHCA to carry out an announced inspection in May before the start of hurricane season. Additionally, it requires the Public Service Commission to ensure that utility companies treat nursing homes and assisted living facilities with at least 50 residents that offer critical medical care as high priorities, similar to hospitals.

HB 443: Filed by state Rep. Emily Slosberg, D-Boca Raton, requires nursing homes and assisted living facilities to have current contact information on file with both residents and the state Long-Term Care Ombudsman. It also mandates that residents be allowed to access personal records on file at the facility.

SB 830: Filed by Farmer, this bill is identical to HB 443.

SB 558: Filed by state Sen. Daphne Campbell, D-Miami, this bill requires all health care facilities that provide overnight care — including nursing homes and assisted living facilities — to have generators that can power air conditioning and enough fuel for four days. The generators must be able to maintain conditions throughout an entire facility.

HB 435: Filed by state Rep. Larry Lee, D-Port St. Lucie, this bill establishes a matching grant program, funded with $5 million every year through 2023, so that facilities buying generators can get a dollar-for-dollar matching grant from the state on a first-come, first-serve basis. The grant is open to both public and private facilities.

HB 437: Filed by Lee as well, this bill requires facilities to have generators and enough fuel for seven days.

HB 331: Filed by Slosberg, this bill adds new language to the state’s patients bill of rights, requiring facilities to send an explanation for any relocation in writing to both a resident and the Long-Term Care Ombudsman.

 

Ed Kilgore at New York Magazine explains how repealing the Obamacare health-insurance-purchasing mandate, which the president wants, and which is currently part of the Senate tax-cut bill, will effect rural voters of Trump.   A revised Congressional Budget Office estimate shows as many as 13 million people could lose health insurance over ten years, with individual premiums going up about 10 percent a year — a price Senate Republicans appear ready for other people to pay in exchange for $338 billion to devote to tax cuts for corporations and the wealthy.

Now we have some new analysis from the Los Angeles Times on how the mandate repeal might affect specific parts of the country. And it’s bad news for the rural people of Trump Country.

There are 454 counties nationwide with only one health insurer on the marketplace in 2018 and where the cheapest plan available to a 40-year-old consumer costs at least $500 a month. Markets in these places risk collapsing if Congress scraps the individual insurance mandate.

Eighty-six percent of these 454 at-risk counties have fewer than 50,000 residents, census data show. Healthcare costs are often higher in rural areas, as there are fewer medical providers and populations tend to be older and sicker.

These counties also overwhelmingly supported Donald Trump last year, with 9 out of 10 backing the Republican presidential ticket, according to election data.

In addition to Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, the counties are clustered in southwestern Arizona, western Colorado, southern Mississippi, central North Carolina, as well as parts of Georgia, Virginia and West Virginia.

Many of the people affected by this measure probably don’t much like the idea of being told they have to buy health insurance. But they’ll like having no real access to health insurance even less.