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.

The Sentinel reported that Pennsylvania’s Department of Health has placed a temporary manager at the Golden Living nursing home on Poplar Church Road in Camp Hill after ABC27 reported on inspections showing hygiene issues and medication errors in the facility, along with an incident involving maggots in a patient’s feeding tube.  The manager has been at the facility since July 19.

 The Department of Health says several substantiated complaints and “potential for resident harm” led to the decision to place a temporary manager at the facility.   The temporary manager’s job is to evaluate practices and advise management about changes that need to be made.

McKnight’s reported that national for profit nursing home chain Genesis Healthcare has agreed to settle with the DOJ for $52.7 million under an “agreement in principle” to settle four separate U.S. Department of Justice investigations.  The provider currently operates nursing homes in 34 states and employs nearly 90,000 workers nationwide.

The settlement will resolve allegations over inadequate staffing numbers at several of the provider’s long-term care facilities from 2005 through 2013, along with allegations of billing fraud for hospice services. The settlement covers alleged Medicare rule violations for physical therapy at two subsidiaries owned by Genesis.

Genesis said it has already set aside $39.1 million for the settlement, but it expects to record an additional loss contingency expense of $13.6 million in the second quarter of 2016 as a result of the lawsuits. They added that they plan to pay the full amount over a period of five years.

 

CNBC reported the “largest single criminal health-care fraud case ever brought against individuals” by the U.S. Justice Department — an alleged Medicare fraud and money laundering scheme that netted participants a whopping $1 billion since 2009.  Philip Esformes, the owner of more than 30 Miami-area skilled nursing and assisted living facilities, as well as a hospital administrator and a physician’s assistant were charged in an indictment with conspiracy, money laundering and health-care fraud, the U.S. Attorney’s office in Miami said.  “Esformes is alleged to have been at the top of a complex and profitable health-care fraud scheme that resulted in staggering losses — in excess of $1 billion,” said FBI Special Agent in Charge George Piro. Prosecutors say that Esformes operated the Esformes Network for “more than 14 years … to enrich himself through false and fraudulent billings.”

The indictments claim that the massive scam cycled thousands of Medicare and Medicaid beneficiaries through his Esformes Network facilities despite the fact they didn’t qualify for such care and helped Esformes, fund a lavish Trumpian lifestyle that included private jets, a $600,000 watch, meetings with escorts in hotel rooms, and a private basketball coach for his son.

At those facilities, prosecutors said, they also “received medically unnecessary services that were billed to Medicare and Medicaid,” the government-run health programs that cover senior citizens and the poor.

“Furthermore, Defendant [Esformes] and his co-conspirators preyed upon his beneficiaries addictions by providing them with narcotics so that the beneficiaries would remain in Esformes Network facilities, allowing the cycle of fraud [to] continue,” prosecutors said in a court filing.  “Among the thousands of people cycled through the fraudulent network were, for example, drug addicts who were allegedly prescribed opioids – including OxyContin and Fentanyl – and other narcotics in order to entice them to stay in facilities where they didn’t belong,” she said at a news conference.

Prosecutors said Esformes faces a potential prison term of life imprisonment under federal sentencing guidelines.

In addition to Esformes, 49-year-old Odette Barcha, who had been director of outreach programs at Larkin Community Hospital, and physician’s assistant Arnaldo Carmouze, 56, also were charged in the case and arrested.  Esformes and his co-conspirators are alleged to have further enriched themselves by receiving kickbacks in order to steer Medicare beneficiaries to other health-care providers — including community mental health centers and home health-care providers — who also performed medically unnecessary treatments that were billed to Medicare and Medicaid, the office said.

According to court documents, Esformes paid $15.4 million in 2006 to resolve civil federal health care fraud claims for similar charges.  But authorities said Esformes was able to continue with alleged crimes after that date through a sophisticated money laundering scheme.

See additional article at Fox News.

 

 

 

 

 

Newsday and Long Island Business News reported the $28 million settlement between Medford Multicare Center for Living and its owners Mordechai Klein; Susan Aschkenazi; Norman Rausman; and Rausman’s kin, Martin Rausman, Michael Rausman and Henry Rausman, all of Monsey and NY Attorney General Eric T. Schneiderman.

The owners were accused of paying themselves millions in public funds while slashing costs that negatively affected patient care.  The owners were accused of corporate looting for diverting $60 million of the $280 million in Medicaid funds toward exorbitant salaries, management fees and charitable donations to their family-controlled private foundations since 2003.  The owners also agreed to adopt a host of reforms to improve the quality of care at Medford including to hire an outside operator and a financial monitor to oversee the 320-bed facility for five years.

“Nothing is more important than securing the safety of those in nursing home facilities, yet, as alleged in our complaint, Medford owners continued to line their pockets with millions in public funding while Medford cut staffing, services and supervision, shirking the duty of caring for some of our most vulnerable citizens,” he added.

Medford is the home where a resident died in 2012 after the staff failed to connect the patient to a ventilator and ignored alarms that indicated the patient stopped breathing.  Aurelia Rios, 72, died Oct. 26, 2012, because seven employees failed to do their jobs, and two others attempted to hide the true cause of her death.

“Today we have taken significant steps to ensure residents at Medford receive necessary and proper care, and that the tragic events of 2012 are never repeated,” Schneiderman said in a statement. “This settlement sends a clear message that those who profit from Medicaid at the expense of nursing home residents will be held accountable.”

 

 

 

 

The Centers for Medicare and Medicaid Services (CMS) release an “Enforcement Report” with information about nursing home provider enforcement from 2006 to 2014.  The CMS enforcement reports provide information about CMS and state survey agency enforcement actions for all surveys from 2006 to 2014.   The release is part of the agency’s “ongoing efforts to ensure transparency, consistency of application of enforcement remedies, and data management to track enforcement actions across the nation.”