The former owner of several nursing homes has been sentenced to 42 months of imprisonment after being convicted of health care fraud and money laundering.  Rocky Lemon pled guilty on both charges.

In addition to the prison term the owner must serve three years of supervised release after completing his imprisonment and pay more than $4 million in restitution to Medicare and Medicaid. 

From 1997 to April 2001, Lemon owned and operated more than 50 nursing homes through TLC Healthcare Inc.

Lemon admitted that he executed a scheme to defraud the Medicare Program and the Texas Medicaid Program by diverting Medicare and Medicaid money to his own personal use and benefit.

Lemon used some of that Medicare and Medicaid money to finance his purchase of nursing homes, then sold some of the nursing homes for profit and funneled a portion of the net proceeds into his personal bank and brokerage accounts.

See article here

The Government Accountability Office (GAO) has finally concluded what we all knew to be true:  Nursing homes go unpunished for the abuse and neglect suffered by residents. See story here

Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment of patients.  As a result, nursing homes cycle in and out of compliance with federal standards and pose a continued threat to the health and safety of patients.

”Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued this week by the Government Accountability Office, an investigative arm of Congress.

The Department of Health and Human Services ”fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Congress established stringent standards for nursing homes in 1987. In 1998, the GAO reported that ”homes can repeatedly harm residents without facing sanctions.”  About 1.5 million people live in the nation’s 16,400 nursing homes on any given day.

The GAO said federal health officials hesitated to impose fines of more than $200 a day, in part because they believed that larger penalties ”could bankrupt some homes.” Fines are generally so small that nursing homes view them as a ”cost of doing business,” with ”no more effect than a slap on the wrist,” the report said.

Here is a good example where a nursing home was fined for overmedicating a resident and then officials withdrew the fine!

Many residents are totally reliant on staff for care, and rely on the federal Medicare program to pay the bills. The problem at nursing homes is poor staffing.  I just read an article that discusses the issue and explains how and why it is a system wide problem.

The article talks about an investigation that found the staffing shortage wasn’t an oversight.  The homes and their upper management were "padding their balance sheets on the backs of helpless residents in their care".

“They were all trying to make a buck,” said Alan Peak, an FBI agent in the white collar crimes unit. The probe revealed criminal conditions at the nursing homes—residents suffering from bed sores, malnutrition, beatings, neglect—all the result of their management company’s directives to cut costs. Meanwhile, managers rewarded themselves handsomely for their efficiency.

The fraud prosecution is one of the first of its kind. While systematically cutting back on service at the nursing homes, management continued to collect money from Medicare and Medicaid for services they knew were inadequate, or in some cases not performed at all.

The management company and its CEO, as well as the nursing homes, pled guilty last fall to fraud conspiracy charges. In February, the CEO was sentenced to 18 months in prison, and the nursing homes were each fined $180,000. The company president was sentenced April 20 to two months in prison for his role.

 

The Michigan AG is trying to stop the abuse and neglect of nursing home residents.  A Metron’s Greenville Nursing Home is facing a $100,00 fine for what the Michigan Attorney General calls "quality of care deficiencies."

The penalty was imposed against Metron for bed rail issues involving several residents earlier this year. This incident follows criminal charges the Attorney General brought in February 2006 against eight employees of the Metron facility in Big Rapids. The charges stemmed from the death of Sarah Comer in January 2005.

See more information here

In past years, the bill came close to passing but failed because of lack of support in the House of Representatives. Therefore, it is extremely important to get members of the House to co-sponsor and support the bill this year.

Please contact your U.S. Representative’s office and ask for him or her to co-sponsor the Elder Justice Act, H.R. 1783. Ask them to support this bill because:

  • Abuse and neglect of the elderly in long-term care settings are serious problems. (If you can, give a local example that shows this.)
  • Abuse and neglect are under-reported; but even so, long-term care ombudsmen across the country receive over 16,000 complaints a year about abuse, gross neglect, and exploitation. (If you have one, substitute a statistic from your state or area that shows the amount of abuse or neglect in your local facilities.)
  • The Elder Justice Act will help public agencies combat abuse against all elderly. It is the strongest legislation introduced to protect nursing home residents in the past 20 years.
  • There are several ways to contact your Representative:
    Call the U.S. Congress switchboard at 202/224-3121. They will put you through to the Representative’s office, and you can give your message to the person who answers the phone.
  • The Elder Justice Act provides for a wide range of programs and grants to improve detection and handling of elder abuse. A number of provisions are directly related to protecting residents in nursing homes and/or other long-term care facilities. These would:
  • Improve forensic investigation of elder abuse.
  • Require the number of adjudicated criminal violations by facilities or their staffs to be published on Nursing Home Compare.
  • Provide for a consumer rights information page on Nursing Home Compare.
  • Authorize new funding to improve ombudsman capacity and training.
  • Authorize a national training insitute for long-term care surveyors.
  • Require operators and empoyees of any long-term care facility that receives federal funds to report "any reasonable suspicion of a crime" to law enforcement; establish fines for those who fail to report and protection from retaliation for those who do.
  • Require nursing homes that are voluntarily closing to give 60 days notice to the state survey agency and provide a plan to relocate residents.
  • Authorize a report to recommend legislation or administrative action to establish a national criminal background check system for nursing home workers.
  • Authorize a study on establishing a national nurse aide registry.

Woman fell nine times in 7 months, and didn’t get 22 doses of necessary medications but the State only fined the home $1500. 

A resident fell nine times in seven months before anyone at her nursing home acted to prevent further falls. Her chart also describes six weeks last fall when she was behaving wildly — yelling, pacing, threatening staff and taking off her clothes, among other things. But none of her caregivers connected that to the fact that they failed during those same weeks to give her 22 doses of a drug to treat her mental illness.

For failing to provide that necessary care, Santa Rosa Care Center paid a $1,500 fine last week to the Arizona Department of Health Services, which licenses nursing homes and other elder-care facilities.
Last week’s $1,500 fine was the second penalty Santa Rosa has paid since Oct. 31. The home paid $3,500 after a March 2006 complaint investigation documented that a male nurse and two other staffers were verbally, emotionally and physically abusive to seven residents.

One of the residents was kicked, another was restrained with a choke hold, another had his arm twisted behind his back, and several of the residents said staff members had yelled at them.

The purpose of a fine is "to create enough incentive to stay in compliance (with state licensing rules) but to not be so detrimental to the facility as to pull too many resources away from patient care," Wynn said.
Grabel said he thought the penalty was low, "considering what happened to the patient … If the individual had nine falls, there should have been a fall-prevention plan that was implemented for her. If there was a problem with her getting her meds appropriately, then that also should have been taken care of as part of a plan. We need to make sure that we have better care for our elderly."

See link for full story www.tdn.com/articles/2007/04/15/top_story/news01.prt

Two formers owner of two Bronx County nursing homes defrauded the Medicaid program of millions of dollars by overcharging for services at two facilities over a six-year period.

From 1997 to 2003, Zelmanowicz, through his nursing homes, submitted bills to Medicaid fraudulently claiming that the facilities were entitled to payments for reserving or “holding” residents’ rooms during periods when the residents were temporarily hospitalized, commonly referred to as “bed holds.”

See link www.midhudsonmostwanted.com/stories/20070413-03.htm

FRIDAY, DECEMBER 15, 2000

(202) 514-2007

WWW.USDOJ.GOV

TDD (202) 514-1888

TENNESSEE-BASED NATIONAL HEALTHCARE CORPORATION

SETTLES MEDICARE FRAUD CASE FOR $27 MILLION

WASHINGTON, DC – National Healthcare Corporation (NHC) will pay the United States $27 million to resolve allegations under the False Claims Act that the company submitted falsely inflated reports to Medicare, the Justice Department announced today. The government alleged that beginning in 1991 the company submitted nursing home cost reports that falsely claimed that facility staff members spent more time caring for Medicare patients than they actually did in order to collect additional money from the federal health care program.

The complaint against NHC alleges that the company submitted cost reports that included false claims for reimbursement. NHC, headquartered in Murfreesboro, Tennessee, owns, leases or provides services to 105 nursing homes nationwide.

"Today’s settlement by the Justice Department demonstrates the government’s determination to combat health care fraud by providers," said David W. Ogden, Assistant Attorney General of the Department of Justice’s Civil Division.

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