The New Yorker Magazine had an article on how and why U.S. Attorney Preet Bharara was fired because of his investigation into Secretary Price. Bharara met with Trump at Trump Tower.  When Bharara left the meeting, he informed reporters that the president-elect had asked if he were willing to remain in his post, and that he had answered in the affirmative.  Then suddenly Trump asked Bharara and 45 other U.S. Attorneys to resign. Bharara refused to tender his resignation. He was then fired.

Bharara announced his unemployment on Twitter, and then posted this enigmatic remark:

Bharara’s implication, then, was that his office was investigating something that the White House preferred to keep quiet. The former U.S. Attorney was overseeing an investigation of Health Secretary Tom Price’s stock trades prior to his firing, according to a source who spoke with ProPublica.

In December, the The Wall Street Journal reported that the former congressman had traded more than $300,000 worth of stock in health companies over a four-year period — during which he pushed legislation that could have benefited those companies.

Since then, three of Price’s trades have drawn heightened scrutiny:

(1) In March 2016, Price bought $15,000 worth of stock in Zimmer Biomet, a medical-device company. Two days later, the congressman introduced a bill that would have protected that company from a cut in its Medicare reimbursement rate. Zimmer Biomet then put money in his campaign coffers.

(2) That same month, Price purchased thousands of dollars worth of stock in six pharmaceutical companies — and then led a legislative and public-relations effort to defeat regulations that would have (almost certainly) hurt those companies’s profits.

(3) Last summer, Price made a bulk purchase of discounted shares in Innate Immuno, an Australian biotechnology company. Shortly thereafter, he helped push through legislation that expedites the FDA’s approval process — a reform that directly benefits Innate Immuno, which is working to get its wares onto the U.S. market. Price has already enjoyed a 400 percent paper gain on his investment in the company.

The Wall Street Journal found that “the cabinet nominee was one of fewer than 20 U.S. investors who were invited last year to buy discounted shares of the company — an opportunity that, for Mr. Price, arose from an invitation from a company director and fellow congressman.”

In January, Democratic Representative Louise Slaughter asked the SEC to investigate Price’s trades, arguing that there was reason to suspect that he had violated the STOCK Act — a 2012 law that bars members of Congress from using nonpublic information for personal profit.

Bharara’s office was also reportedly investigating Fox News for an array of potential crimes, including whether the network’s executives committed wire fraud by allegedly hiding financial settlements paid to women who had accused Roger Ailes of sexual harassment.

The Orlando Sentinel had an editorial about a grave injustice in Florida.

There are few more consequential or critical decisions for families than choosing the right nursing home or assisted-living facility for a parent or other elderly relative who needs long-term care. For those families, Florida’s licensing agency for health care promises some peace of mind: “easy access” to its information on “provider performance.” Such reporting “is a key element that promotes enhanced patient care and consumer choice,” according to the website of the state Agency for Health Care Administration.

But as the Sentinel’s Kate Santich reported this week, AHCA has not been keeping its promise on inspection reports for nursing homes and assisted-living facilities, where more than 160,000 of Florida’s most vulnerable residents live. Basic information — dates, places and key details — has been blacked out in those reports.

AHCA officials blamed the redactions on the need to comply with federal health-privacy laws, which were made more stringent in 2009. But regular followers of the state inspection reports told Santich that they observed a trend toward withholding details within the past few months.

And the censored words go well beyond personally identifying medical information, such as names, Social Security numbers or dates of birth. Those details have always been exempt from public disclosure requirements.

Santich’s story included a passage from one inspection report of “a resident in the bathtub, with the water running, slumped over and ——-.” Another report referred to “a body floating in the ——.”

Nathan Carter, an Orlando personal injury attorney who said he has been reviewing the reports for 20 years, told Santich that the state’s redaction process has become “arbitrary and inconsistent.” He accused the agency of trying to make the reports “useless” by removing “substantive information.”

Deleting substantive information from inspection reports or, even worse, withholding them, would make long-term care facilities less vulnerable to lawsuits alleging abuse or neglect. The daughter of a man who died in 2008 in a Lake Worth nursing home told Santich she needed the intervention of a state legislator to get AHCA to release its inspection reports on the facility. The man’s family eventually won a $2 million wrongful death case against the nursing home.

A spokeswoman for AHCA told Santich that the agency is now using an automated process “to redact documents efficiently.” She conceded that “there is [a] possibility that some items may be inadvertently redacted.” The agency is trying to “reduce this as much as possible, but there is the potential for this to continue to happen.”

On the eve of Sunshine Week, an annual commemoration that spotlights the state of open government, censored inspection reports for nursing homes and assisted living facilities are a timely reminder of the need for Floridians and their legislative representatives, now meeting in Tallahassee for their annual session, to protect the right to know.

Brian Lee, who served as the state’s ombudsman for long-term care for seven years, accused AHCA of “blatant” disregard of Florida’s open-records requirements. Michael Milliken, the current ombudsman, said he has contacted AHCA about the problem with the inspection reports, but doesn’t have the authority as an employee of another agency, the Florida Department of Elder Affairs, to change the policy.

Lee, now head of a national watchdog group called Families for Better Care, was forced out of his state position by Gov. Rick Scott in 2011 after clashing with the nursing home industry. Lee has offered an eminently reasonable suggestion to AHCA: Suspend its current automated redaction program until it can come up with a better system.

If the agency won’t comply voluntarily, it’ll be up to legislators who care about the health, safety and dignity of Florida seniors to make sure the veil on AHCA’s inspection reports is lifted.

CNN continued its investigation on the epidemic of sexual assaults in nursing homes.  One article called “Six Women. Three Nursing Homes. And the Man accused of Rape and Abuse” explains how a sexual predator by the name of Luis Gomez could terrorize vulnerable residents for years.  The nursing home managers refused to believe the accusations or even investigate them.

One victim told police that the director of nursing at the Brian Center Health & Rehabilitation, Gail Robertson, reacted to the story with disbelief. She told the resident “to go live under a bridge, because nothing like that happened” in her facility, the woman recalled.  This was not the first or last time Robertson covered up Gomez’s crimes.

With four victims just at the Brian Center, police expanded their investigation to anywhere Gomez had worked. The detectives learned Gomez had been the subject of sexual abuse claims reported at several different facilities.  Officers had been called to investigate Gomez as early as 2011 at Smoky Mountain Health and Rehabilitation Center

Luis Gomez moved to North Carolina from Guatemala when he was 40. After earning his CNA certification in 2000, Gomez first worked as an in-home caregiver. Then he was hired by a nursing home called Autumn Care of Waynesville. During the next 15 or so years, he would bounce between Autumn Care and at least four other nursing homes, including the Brian Center.  He’s been married at least three times, and has a reputation for dating other women on the side. Co-workers reported his “flirting” crossed the line, and he got in trouble for harassing female co-workers.

“He’s a real Jekyll and Hyde,” says Linda Gomez, who is in her 60s now and still married to him.  “My personal opinion is he’s not good to be out in society. If he’s going to do it to an older person … he’s going to do it to anyone.”

The North Carolina Department of Health and Human Services told CNN that all allegations against nursing aides are “investigated, as warranted” and recorded in a state database where potential employers could learn of pending allegations or substantiated findings.

“Unlike law enforcement investigations and criminal cases in which it must be determined that a person committed the alleged offense ‘beyond a reasonable doubt,’ we must simply find that it is ‘more likely than not’ that a person committed the act,” a representative said in an email.

But all of the complaints against Gomez had been deemed “unsubstantiated,” meaning nursing home and state officials ruled they couldn’t be proven. And because the state only flags substantiated complaints about an employee — a policy that’s consistent across the country — any facility looking to hire Gomez would have seen a record showing a longtime nursing aide with no history of problems.

State investigators, working in conjunction with the federal Centers for Medicare & Medicaid Services, ultimately cited the Brian Center for a litany of problems: failure to protect residents from sexual abuse, failure to inform the alleged victims’ families and physicians, failure to report suspicion of a crime immediately to law enforcement, failure to supervise the alleged perpetrator until he left the facility, failure to assess the residents immediately for injuries, failure to notify the state promptly of allegations, failure to empower staff to call law enforcement.

The facility’s parent company which owns and operates the facility, SavaSeniorCare, said “We took steps to keep all of our residents safe from that point forward,” a spokeswoman said by email.

 

CNN conducted a special investigation into the epidemic of sexual assaults and rapes in nursing homes.  “The unthinkable is happening at facilities throughout the country: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them.”

“It’s impossible to know just how many victims are out there. But through an exclusive analysis of state and federal data and interviews with experts, regulators and the families of victims, CNN has found that this little-discussed issue is more widespread than anyone would imagine.”

“Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little — or nothing — to stop it.”

“In cases reviewed by CNN, victims and their families were failed at every stage. Nursing homes were slow to investigate and report allegations because of a reluctance to believe the accusations — or a desire to hide them. Police viewed the claims as unlikely at the outset, dismissing potential victims because of failing memories or jumbled allegations. And because of the high bar set for substantiating abuse, state regulators failed to flag patterns of repeated allegations against a single caregiver.”

It’s these systemic failures that make it especially hard for victims to get justice — and even easier for perpetrators to get away with their crimes.”

“Some accounts of alleged sexual abuse come from civil and criminal court documents filed against nursing homes, assisted living facilities and individuals who work there. Other incidents are buried in detailed reports filed by state health investigators.”

“Most of the cases examined by CNN involved lone actors. But in some cases, a mob mentality fueled the abuse. And it’s not just women who have been victimized.”

“Despite the litany of abuses detailed in government reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities housing the elderly.”

“More than 16,000 complaints of sexual abuse have been reported since 2000 in long-term care facilities (which include both nursing homes and assisted living facilities),according to federal data housed by the Administration for Community Living. But agency officials warned that this figure doesn’t capture everything — only those cases in which state long-term care ombudsmen (who act as advocates for facility residents) were somehow involved in resolving the complaints.”

“The result: CNN exclusively found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities during this period. (This includes some of the cases provided by the Centers for Medicare & Medicaid Services.) And nearly 100 of these facilities have been cited multiple times during the same period.  Complaints and allegations that don’t result in a citation, which the government calls a “deficiency,” aren’t included in these Medicare reports. In addition, national studies have found that a large percentage of rape victims typically never report their assaults. So these numbers likely represent only a fraction of the alleged sexual abuse incidents in nursing homes nationwide.”

“Yet the facilities that currently house more than 1 million senior citizens typically pay low wages to nursing assistants (about $11 or $12 an hour), making it difficult to attract and keep quality workers. And during the most vulnerable hours, the night shift, there are often few supervisors.”

The article discusses numerous horrific examples; I encourage you to read the full article.

Legal advocates, government regulators, criminal investigators and medical experts agree that sexual abuse in nursing homes can be extremely challenging to prevent and detect. But they say many facilities should be doing much more to protect vulnerable residents.

  1. “When you have a sexual assault claim, you shouldn’t go to a conclusion she’s a problem patient. You should investigate as a sexual assault until proven otherwise.” — Dave Young, district attorney for Colorado’s 17th Judicial District
  2. “Preserve evidence! Don’t bathe or change clothing, sheets, etc., when an assault is suspected.” — Sherry Culp, Kentucky long-term care ombudsman
  3. “Most abuse is undetected and never reported mainly because observable signs are missed or misinterpreted. A little training could go a long way.” — Tony Chicotel, staff attorney at California Advocates for Nursing Home Reform
  4. “As with nearly every type of abuse and neglect seen in nursing homes, the better staffed the facility the less likely sexual abuse will occur. This is a crime of opportunity, so the more supervision the better.” — Kirsten Fish, elder abuse attorney
  5. “There needs to be a reporting system. …The system doesn’t keep track of cases that haven’t been substantiated, [and] their rules for substantiating a complaint are just astronomical. It’s virtually impossible to substantiate a complaint.” — Lt. Chris Chandler, Waynesville, North Carolina, Police Department

 

 

WDAY reported on the lack of regulatory oversight in Minnesota. The Minnesota Health Department performed on-site investigations of just 10 percent of the 3,400 complaint allegations it received from the public about nursing home and home-care treatment last year, according to the agency’s statistics. The agency only did on-site inspections of 102 allegations — less than 1 percent — of the nearly 21,000 allegations it received from providers’ reports.

The number of vulnerable adults receiving care and the ease of lodging complaints have both grown in recent years, resulting in an exponential increase in the number of complaints the department takes in.

“Thousands of complaints are not investigated so maltreatment continues, and less severe issues may escalate to more serious harm,” the agency said in a budget request this year. Those uninvestigated complaints in the last year included more than 4,000 falls, nearly 2,000 complaints of emotional or physical abuse by staff and nearly 3,000 “unexplained injuries,” the department said.

Consumer Voice, in partnership with Justice in Aging, has released a new fact sheet entitled “Why-the-Recently-Revised-Nursing-Home-Regulations-Are-Vital-for-Nursing-Home-Residents

After four years of work from the Centers for Medicare & Medicaid Services (CMS), newly revised federal nursing facility regulations were released in September, and most provisions went into effect on November 28.  These revised regulations provide critical consumer protections.  This fact sheet provides an overview of some important new revisions and how they protect long-term care consumers.  Stakeholders and policymakers can use the fact sheet to better understand the role the revised regulations have in improving nursing care, including an increased focus on addressing a resident’s needs and preferences.

Protections Include:

Greater focus on addressing a resident’s individual needs and preferences. A nursing home must learn more about who the resident is as a person, provide greater support for resident preferences, and give residents increased control and choice.

Prompt development of a care plan. The original regulations allowed a resident to be without a care plan for as long as 21 days following admission. Now, a facility must develop and implement a care plan within 48 hours of a resident’s admission.

More comprehensive care. Treatment and services have been expanded to include pain management, dialysis, and behavioral health services.

Improved training. Training requirements have been expanded to apply to all staff, contractual employees, and volunteers. Mandatory topics include communication, residents’ rights, and prevention of abuse, neglect and exploitation. Training for nursing assistants is expanded to include dementia management and resident abuse prevention.

Improved protections against abuse, neglect and exploitation. A nursing home must not employ a licensed individual with a disciplinary action, and must report suspicions of a crime to law enforcement and the state survey and certification agency.

Better protection of resident property. Nursing homes are now required to take reasonable care of resident belongings and can no longer seek waivers of their responsibility for lost or stolen property.

Increased visitation rights. A resident can accept visitors at any time of the day.

Protection against evictions. Eviction for non-payment is not allowed when a third-party payor (such as Medicaid) is evaluating a claim for payment. For evictions based on a nursing home’s supposed inability to meet a resident’s needs, the nursing home must document its attempts to meet the resident’s needs, and the ability of a receiving nursing home to meet those needs.

Limiting nursing home’s ability to “dump” a resident at the hospital. In an effort to evade eviction safeguards, some nursing homes “dump” residents by refusing to readmit them from hospitalizations. Now, a nursing home must follow eviction procedures and give a hospitalized resident an opportunity to appeal, when the nursing home claims that the resident cannot return.

Prohibiting forced arbitration of claims of misconduct. Currently, many nursing home admission agreements compel a resident to bring any future claims about abuse, neglect or other quality of care issues through private arbitration. The revised regulations prohibit nursing homes from forcing residents to arbitrate disputes, but allow voluntary arbitration agreed to after a dispute arises.

The New York Times reported on the list of demand that health insurers want if Trump and the Republican Congress repeal the Affordable Care Act.  The nation’s health insurers publicly outlined what the industry wants.

  1. A clear commitment from the Trump administration that the government will continue offsetting some costs for low-income people.
  2. Keep in place rules that encourage young and healthy people to sign up, which the insurers say are crucial to a stable market for individual buyers.

 If they do not come up with an alternative, more than 24 million people would be left uninsured, including the more than 10 million who have bought individual plans on state marketplaces.

Hospital groups also held a news conference to warn of what they said would be the dire financial consequences of a repeal if the cuts to hospital funding that were part of the Affordable Care Act were not also restored.

These insurers have no desire to return to the time before the law was passed, when people with pre-existing conditions were routinely denied coverage in the individual market.

The insurers are also beginning to discuss a potential overhaul of Medicare, pushed by the House speaker, Paul D. Ryan, who favors so-called premium support, or vouchers, as a way for people to find coverage. “We’re not big fans of that approach,” said Ms. Tavenner, although she said the industry would be open to discussing it.

Ms. Tavenner said the industry wanted to know more about what the Republicans were planning, including information on the fate of the Medicaid expansion under the law. “We still have more questions than answers,” she said. “We don’t want to disrupt individuals who are relying on our coverage,” she said.

There are plenty of reasons to be worried about Tom Price, President-elect Donald Trump’s choice for secretary of Health and Human Services.  Price is an orthopedic surgeon and U.S. congressman from Georgia with no relevant experience.

Price has often and repeatedly voted to cut Medicaid and Medicare,  and is an ardent opponent of female reproductive rights.  Price also belongs to a truly radical medical organization known as the Association of American Physicians and Surgeons with 4,000 members.

The AAPS statement of principles declares that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid.  In particular, it urges “non-participation” in the Social Security amendments of 1965 — also known as Medicare — “as the only legal, moral, and ethical means of concretely expressing their complete disapproval of the spirit and philosophy behind these amendments.

Its website features ridiculous unscientific claims that tobacco taxes harm public health and electronic medical records are a form of “data control” like that employed by the East German secret police. An article on the AAPS website speculated that Barack Obama may have won the presidency by hypnotizing voters.

Their views on medicine are controversial to say the least: such as blaming vaccines for autism, including that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury; denying about HIV/AIDS; that immigrants cause crime and disease; that abortion causes breast cancer to name just a few.

Dr Price’s political agenda is the same self-serving tort reform that does not increase quality, transparency, or accountability including in the Empowering Patients First Act, the bill he has offered as an alternative to the ACA since 2009.  His solution is the same type of ineffective federal tort reform which violates States’ Rights, and includes unconstitutional and arbitrary caps on damages.  The bill would also allow physicians to “balance-bill” Medicare beneficiaries—to charge them more than Medicare’s allowable charge—which is currently illegal.  The bill also proposes a modern day “Star Chamber” or “administrative healthcare tribunals” where a confidential proceeding by anonymous bureaucrats would decide if a jury gets to hear your case.

Be afraid.  Be very afraid.

 

The Star-Tribune reported on the Minnesota Department of Health (MDH) has reversed its earlier decision regarding the death of resident at the Minnesota Veterans Home-Minneapolis nursing home.  The MDH originally determined that the facility did not neglect the resident.  As the Star Tribune reports, “Reversing a previous conclusion, state investigators are faulting management of the state veterans home in Minneapolis for the death of World War II veteran who fell from a mobility sling last year and broke his neck.”

The Minnesota Department of Health said in findings that the nursing home “failed to ensure staff members used the correct slings when transferring vulnerable adults using full body lifts.” Investigators said they found at least two other instances that same summer in which staff used the wrong transfer sling.  Previously, the state investigation labeled its findings “inconclusive.”

 During a transfer in July 2015, the man was moved with a shower sling, which “allowed a shifting of the weight” not found with a regular sling, the state noted. He fell out of the device and died 11 days later, the report said.

See statement from Kosieradzki Smith Law Firm.

The Corporate Whistleblower Center is appealing to health care providers to call them anytime at 866-714-6466 if they possess proof of Medicare over-billing for unnecessary medical procedures involving their employer. According to the Justice Department on October 24th, 2016, “Medicare reimburses skilled nursing facilities at a daily rate that reflects the skilled therapy and nursing needs of their qualifying patients.  The greater the skilled therapy and nursing needs of the patient, the higher the level of Medicare reimbursement.”

A major healthcare provider recently agreed to pay $145 million dollars to settle allegations for over-billing Medicare for unnecessary procedures and the whistleblower in this instance received a $29 million-dollar reward.

The United States alleged in its complaint that the healthcare company instituted corporate-wide policies and practices designed to place as many beneficiaries in the Ultra High reimbursement level irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries. The government also alleged the company sought to keep patients longer than was necessary in order to-continue billing for rehabilitation therapy, even after the treating therapists felt that therapy should be discontinued.