It’s no secret that some nursing homes will neglect their residents in the interest of their own greed for profits and wealth, but less well known is the fact that those nursing homes are often rewarded by the government for that mistreatment. NPR recently published an article on this topic, citing statistics like one in five nursing home residents sent from hospitals on Medicare are returned to the hospital within thirty days.

Rather than taking care of their patients to the best possible extent, hospitals and nursing homes choose to send them back and forth to one another because it benefits them financially. For one thing, it’s cheaper for each facility to treat a patient as little as possible. For another, both hospitals and nursing homes have historically received encouragement from the government for this behavior, getting financial rewards for things like admission, readmission, and discharge to and from the facility.

As an example, an elderly woman could be admitted to a hospital for a severe injury. She could then be transferred from there to a nursing home earlier than the injury demands because it’s in the hospital’s financial interest to move her out as fast as possible. Then, at the nursing home, she doesn’t receive the care she needs because the place is understaffed and it costs more money than they wish to pay to properly treat and rehabilitate her. So she gets sicker and they eventually send her back to the hospital. This act of “boomeranging” patients back and forth is well known in the world of health policy.

Noticing this trend, the government has begun its efforts toward fixing the situation. According to NPR, “In 2013, Medicare began fining hospitals for high readmission rates in an attempt to curtail premature discharges and to encourage hospitals to refer patients to nursing homes with good track records.” There are also plans to incentivize nursing homes to improve in similar ways.

These moves are a step in the right direction, but most believe there’s still a lot to do here in the interest of patient care.

The Stamford Advocate reported that St. Camillus Center was fined only $6,000 by Connecticut’s health department and three employees were fired following the death of a resident who hadn’t been checked on for 12 hours.  The footage also showed staff had not opened the door to the resident’s room or checked on the resident between 6:26 p.m. on Feb. 15 and 5:19 a.m. on Feb. 16.

In the Feb. 16 incident in Stamford, a resident with lung cancer was found unresponsive and without a pulse, according to DPH, and video footage subsequently showed staff waited 10 minutes to administer CPR.  The resident was taken to the hospital and later pronounced dead. A registered nurse, licensed practical nurse and nurse aide subsequently were terminated, DPH said.

Past incidents at St. Camillus

2016 – Inspectors report observing 40 violations at the nursing home over the past year, including an incident in which a nursing aide called patients fat. As a result of the observations from unannounced visits in 2015 and 2016, the nursing home failed to meet certain state Department of Health standards during annual licensing inspections.

2014 – The facility receives a $1,680 fine related to protection of patients’ rights and/or failure to monitor patient condition.

2010 – The state Department of Social Services threatened to shut down the center and revoke its eligibility to collect Medicaid after investigators find patients’ health in immediate jeopardy.

According to Medicare’s website, St. Camillus has 124 beds and has not received any federal penalties or payment denials by Medicare in the last three years. However, the site received a lower-than-average health inspection rating a year ago after being cited nine times for deficiencies in quality of life and care as well as other issues.

 

 

New York Magazine recently published an article on findings that the Purdue Pharma company was aware of its product OxyContin’s popularity and addictive nature long before the company’s executives admitted in testimony under oath.  They intentionally ignored and covered up the dangers to exploit consumers and increase their profits.

In the 1990’s, when OxyContin was created, it was dubiously advertised as less addictive than other painkillers and much safer for long-term use than its competitors. Of course, knowing now the opioid crisis America faces, this is not the case. But when asked about their knowledge of their drug’s popularity in the world of drug abuse, Purdue’s top executives said they didn’t know until the early 2000’s.

Then, the Justice Department produced a report with proof that Purdue Pharma knew about OxyContin’s addictive nature and abuse by the late 1990s, only years after the drug was first produced.

Though the administration handling the case at the time did not view it as anything more than a misbranding case, this corporation’s lack of action against the harm its product caused is shameful at the least.

Signature Healthcare is a national for-profit nursing home chain with more than two dozen facilities in Tennessee.  The government started an investigation in 2014 when two whistleblowers started collecting evidence on their own.  LeeAnn Holt and Kristi Emerson, both of whom are occupational therapists from Columbia, collected reams of anecdotes — in part, because they were concerned they might get in trouble themselves.  That evidence is the basis of the $30 million settlement in the Medicare fraud case between the federal government and Louisville-based Signature Healthcare, which operates more than 100 facilities in 17 states.

According to court documents, state and federal investigators discovered Signature was “knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary” at 115 of its facilities. Investigators said that led to a total of $232 million in false claims. The company also allegedly forged documents submitted to Tennessee’s Medicaid or Tenncare program, leading to another $12 million in fraudulent reimbursements.  So they stole $232 million but only had to pay a settlement of $30 million.  Who says crime doesn’t pay?

The complaint against Signature Healthcare (download here) accuses the company of systematically administering occupational, physical and speech therapy when it wasn’t warranted and withholding care when government reimbursements were already maxed out. According to the suit, the unnecessary therapy pushed patients into a category where the facility was reimbursed more per day for those patients, often hitting precisely the 720-minute per week threshold for maximum payment.  Holt and Kristi Emerson are the whistle-blowers who exposed a company-wide system of over-billing the federal government by Signature Healthcare.

“There were a couple of times when things happened with patients where we would just look at each other and say, ‘We can’t do this. We just cannot do this any more,'” LeeAnn Holt recalled.  Holt recalls a patient with advanced cancer who just wanted to spend time with her family rather than continue with therapy.

“She just put her hand on the therapist and said, ‘Honey, you need to go work with somebody that can really benefit from this.’ And you know, when you have a patient that is telling you that, you really have to stop and take inventory of what is going on here.”

Emerson says she hopes the case will still inspire other health care workers to push back when they feel pressured to do procedures they deem medically unnecessary.

“We can’t just blame these corporations for all of this,” she says. “We have to shoulder as therapists some of the responsibility because we’ve allowed this to get this bad.”

The women say before filing their suit, they repeatedly went to administrators all the way up to the corporate office.

“And no one was doing anything. And the more we reported, the more they came in and just started pushing back on us,” Emerson explained.

Emerson and Holt were let go amid the investigation and have found it difficult to find stable work. “No one really wants a whistleblower in their building,” Emerson says.

But now they will split roughly $6 million as their share of the settlement. Whistleblowers are entitled to 15 percent to 25 percent of the total.

 

New York Magazine had an article about Trump’s decision to withdraw protections from people with pre-existing conditions claiming their are “unconstitutional”.  Republicans kept versions of the Affordable Care Act’s protections for people with preexisting conditions in all of their health-care bills last year.  Now Trump and Sessions are attempting to take them away.

“Specifically, the Justice Department announced that it would not defend the Affordable Care Act from a challenge brought by a group of red states, which claims that Congress’s repeal of the individual mandate renders the rest of the law unconstitutional — as that provision is not severable from the rest. This is a legal claim so radical and ill-supported it made the National Review blush. The notion that Congress is not constitutionally allowed to eliminate the ACA’s insurance mandate — unless it also repeals the law’s other regulations of the health-care market — is not some sacred principle of constitutional originalists. Rather, it’s a transparently ad hoc rationalization for the judiciary to veto a duly-passed expansion of the safety net. And yet, Attorney General Jeff Sessions concluded that his department could make no honest argument against the plaintiffs’ case.”

“Out-of-pocket health-care costs are rising for virtually everyone in the United States. Drug prices are resolutely high, premiums on the individual market are skyrocketing (thanks to the GOP’s tireless efforts to sabotage said market), and the average deductible for those with employer-provided insurance has increased by nearly 400 percent since 2006. The Democratic Party’s prescription is for the government to impose price controls, while further subsidizing ordinary Americans’ health-care costs by raising taxes on the rich (the party is internally divided over the details of its policy, but united on its general direction). The Republican Party, by contrast, is beholden to reactionary interests who want the government to cut public spending on health care, so as to finance ever-lower taxes on the wealthy and corporations.”

 

We are happy to share a guest post from Cohen & Cohen, P.C., who are great trial lawyers in Washington D.C.  

One of the main factors employers look at before deciding on whether or not to grant workers’ compensation benefits is if the injury is work related or not. In order to qualify for benefits, you have to show that you sustained the injury while doing a work-related task. Let’s take a closer look at some common scenarios:

Lunch Breaks 

If you got injured while on your lunch break, you may or may not qualify for benefits. For instance, if you were walking to a restaurant and fell on the sidewalk, you generally won’t be eligible for benefits. However, if you were eating lunch in the employee break room and got hurt, the injury will typically be considered work-related and you will qualify for benefits.

Travel 

Typically, workers’ compensation won’t cover injuries that were sustained while traveling to and from work. However, there are some exceptions. For example, if you were driving a company vehicle, running errands for your boss or going on a business trip and suffered an injury, you may be entitled to benefits.

Injuries that Developed Over Time 

Not all work injuries happen all of a sudden. Some of them, including repetitive stress injuries, occur over a long period of time. While these injuries do qualify for workers’ compensation benefits, they can be difficult to prove. You will have to have evidence that these injuries did indeed occur at work and not somewhere else.

Company Outings 

Many companies nowadays hold events for their employees throughout the year, including baseball games, picnics and barbecues. These events are typically considered work-related and any injuries sustained during those events qualify for workers’ compensation benefits.

Improper Conduct 

Employees who got injured while breaking a safety rule or doing something else that their employer disapproves may not be eligible for workers’ compensation. For instance, if you got hurt while under the influence of drugs or alcohol or while trying to hurt another person, you won’t qualify for benefits. You may also be ineligible to receive benefits if you got injured while you were engaged in horseplay. However, if your employer condoned that kind of behavior, it might be a different story.

Hiring a Workers’ Compensation Lawyer 

If you are having trouble that your injury is work related, it may be a good idea to consult with a workers’ compensation attorney Washington D.C. residents trust. He or she has dealt with these kinds of situations in the past and will know if you qualify for benefits or not. If you do qualify, your lawyer can help you file a timely claim.

During your initial meeting with a workers’ compensation lawyer, be prepared to answer several questions about your case, such as where your injury took place what kind of injury you sustained. If you have any evidence, such as medical records or witness statements, bring them with you.

Many workers’ compensation lawyers offer free initial consultations, so there’s no risk to speaking to one.

Thanks to our friends and contributors from Cohen & Cohen, P.C., for their insight into workers’ compensation.

PennLive is taking a hard look at nursing homes that were formerly operated by Golden Living.  The Texas-based chain-long battered by lawsuits and accusations of poor care (and rightly so!)- sold all 35 of its Pennsylvania homes between 2016 and 2017.

However, there are signs that problems remain in many of those homes.

If you or your loved one has any experience with these facilities – whether good or bad – please take a moment to fill out the form for PennLive on the link above, making sure to include accurate contact information. PennLive states that No information that you provide will be published without your permission.

If you’re unsure whether you or your loved one is in a former Golden Living nursing home, take a quick look at the list on the link above.

If you prefer, you can also reach PennLive reporter Daniel Simmons-Ritchie at simmons-ritchie@pennlive.com or at 717-255-8162.

McKnight’s had an article about FDA concerns over the use of Nuedexta as a chemical restraint.  Nuedexta is the only drug approved to treat uncontrolled laughing and crying due to pseudobulbar affect.  However, some nursing homes are using it for residents without pseudobulbar affect.   It’s a rare condition yet the U.S. government is cautioning private insurers to look for suspicious off-label use there because officials fear the drug is being misused to control behavior.

A CNN investigation published in October found Nuedexta’s maker had been “aggressively targeting frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe.”   CNN unearthed what seems to be a concentrated effort to keep the increasingly controversial drug in nursing home’s formularies.  The station obtained complaints sent to the Food and Drug Administration from insurers and nursing home physicians who questioned the maker’s marketing and advertising tactics.

In a follow-up article published Monday, the news organization said the Centers for Medicare & Medicaid Services issued a March memo asking Medicare Part D providers to monitor prescriptions for appropriate use.

The CMS memo told plan sponsors that Nuedexta is only approved to treat pseudobulbar affect, and that they are legally required to ensure the drug is only covered for medically-accepted prescriptions. Neudexta’s maker, Avanir Pharmaceuticals, has said that dementia patients may suffer from PBA.  No medical research supports that contention.  Since the drug launched in 2011, CNN reports Avanir has generated millions of dollars in annual sales in nursing homes.

McKnight’s had another great article on the ongoing use of anti-psychotics in nursing homes.  Approximately 20% of nursing home residents — more than 250,000 nationwide — are still receiving antipsychotic drugs as part of their long-term care treatment despite the well known dangers of off-label use of these medications.  The Long-Term Care Community Coalition claims only 2% of the population will ever have a diagnosis for a condition which the government uses when it risk-adjusts for potentially appropriate use.

Despite concerted industry and government efforts to phase out the use of certain drugs, nursing homes are still placing residents at risk of known dangerous side effects. The use of antipsychotics has been watched closely since at least 1987, when a sweeping new nursing home reform law prohibited inappropriate drugging and the use of chemical restraints. In 2005, the Food and Drug Administration issued a “Black-Box Warning” on serious risks of atypical antipsychotic drugs for elderly patients with dementia.  Several patient advocacy organizations have continued to criticize their prevalence in long-term care.

“Too many residents and families are not even made aware of the dangerous potential side-effects of these drugs, or the fact that they are not clinically indicated for so-called dementia ‘behaviors,’” said Richard Mollot, executive director of LTCCC. The New York State based coalition of consumer, community, civic and professional organizations says its goals including raising quality and accountability of care.

The analysis, based on first-quarter information for 2018, provides usage rates for “every” U.S. nursing home and provides state breakdowns.

In February, Human Rights Watch issued “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” a scathing report that estimated 179,000 U.S. nursing home residents are given antipsychotics without an appropriate diagnosis each week.

At the time, providers and a national association representing them said the report ignored the improvements made in nursing homes since the Centers for Medicare & Medicaid Services set a 15% reduction target in 2012.

In March, AHCA announced its latest round of quality initiatives would push providers nationwide to reduce their off-label use of antipsychotics by another 10%.

CMS has also linked financial outcomes to quality improvements and prescription management.

McKnight’s reported that a judge has ordered the appointment of a special prosecutor to investigate an $80,000 wire transfer from a nursing home owner to a former state senator’s construction company — money that allegedly moved just days after the lawmaker introduced an amendment to limit negligence claims in Arkansas.

Sebastian County Prosecutor Dan Shue asked for an outside investigator to avoid any potential conflict of interest. The Times-Record also reported that Shue has asked the local U.S. Attorney to determine whether the wire transfer violated any federal law.

Jake Files (R), the one-time Fort Smith lawmaker at the center of the case, pleaded guilty in January to unrelated charges and is scheduled to be sentenced June 18. He faces counts of wire fraud, bank fraud and money laundering in relation to improper use of state improvement funds intended for a local sports complex.

The Times Record first discovered the 2014 nursing-home related transfer in civil court documents last year.

The money came from David Norsworthy, part owner in a dozen Arkansas nursing homes. It followed on the heels of a constitutional amendment that sought to limit damage lawsuits — like negligence claims commonly pursued against nursing homes — to $500,000.

That amendment failed then, but it found new life in the current session, before Files resigned in January.

Neither Files nor Norsworthy have explained the $80,000 transfer with media or in court.

The Arkansas Times reports the case has become an issue for those who support  limiting lawsuits through Issue 1, a bill that has been publicly backed by nursing homes, doctors and chambers of commerce.