New Mexico Attorney General Hector Balderas is trying to stop elderly abuse in nursing homes.  KFOX TV reported that New Mexico’s attorney general is launching a new campaign to prevent elderly abuse in nursing homes.

He’s ordered the state to review documents and evidence of abuse that would lead to an investigation on any facility.

“We also look at whether or not they are being cared for appropriately, according to their care plan, and we also look at a variety of injuries and things of that nature,” said Richard Chavez, the AG’s special agent supervisor.

Once enough evidence is gathered, the attorney general’s office will try to prosecute offending homes.

The Miami Herald reported the criminal charges of bribery against Bertha Blanco, a Florida health care administrator in exchange for helping a nursing home owner accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme keep his license.  The wide-ranging investigation that federal authorities are calling the nation’s biggest health fraud case.

Blanco made about $31,300 a year overseeing inspections at nursing facilities owned by Philip Esformes, a wealthy businessman who owns dozens of Miami-Dade nursing facilities as well as homes in Miami, Los Angeles and Chicago.

A criminal complaint filed against Blanco accused her of taking tens of thousands of dollars in cash in exchange for tipping Esformes off about violations so he could address them before state inspections.  Blanco’s aid allowed Esformes to keep his license active and continue billing the federal government for questionable patient services.

Federal authorities say Blanco took the bribes and provided patient and inspection records to intermediaries, who delivered the information to Esformes.  Two of those intermediaries, brothers Gabriel and Guillermo Delgado, have made plea deals and are expected to testify against Esformes. The brothers helped investigators get to Esformes by videotaping a cash transaction that prosecutors said was meant to go for bribes.

Esformes is accused of using his 20 nursing facilities to file false Medicare and Medicaid claims for services that were not necessary for 14,000 patients.

Prosecutors said his health care network and other co-conspirators billed $1 billion for fraudulent services between 2009 and 2016.

The New York Times had an article about “Special Focus Facilities”.  Special Focus Facilities are the worse of the worse nursing homes.  “Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The Centers for Medicare and Medicaid Services, or C.M.S., assign each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.”

Designation requires the facility to immediately fix violations in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive.

“While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to an analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.”

Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement.  Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties. Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, the analysis found.

More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts. This year, the $2.6 million budget allows only 88 nursing homes to receive the designation, though regulators identified 435 as warranting scrutiny.  Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, the analysis shows.

WSOCTV reported that the North Carolina Department of Health and Human Services investigators visited Lake Park Nursing and Rehabilitation Center three days after Channel 9 exposed allegations of patient abuse.  Investigators spent four days at Lake Park nursing home and found repeat problems.

State officials said that their visit was in response to a new complaint in March.  The investigation stated that a patient had not received a shower in two weeks and staff provided him with a washcloth to wash his face, “but that’s it.” The facility was also cited for “neglecting to feed and provide incontinence care for dependent residents.”

Channel 9 uncovered two lawsuits against the facility that are alleging sexual assault and abuse.

The continued failure of the facility during three federal surveys of record show a pattern of the facility’s inability to sustain an effective Quality Assurance Program.

Lake Park nursing is a special focus facility, one of only about 80 in the country, which means it has a history of persistent poor quality, according to Medicare.  Medicare said the facility has shown ‘no improvement for 12 months.

In the report, the facility’s administrator blames family members. “One of the biggest barriers to achieving substantial compliance is difficult families,” it read.

 

The state is now investigating a local nursing home days after a Channel 9 investigation exposed allegations of abuse. [Nursing home faces lawsuits after employee pleads guilty to sexually assaulting patient].

The Channel 9 investigation aired Thursday and by the weekend, state investigators were at Lake Park Nursing and Rehabilitation Center in Indian Trail. Eyewitness News anchor John Paul went back to the facility looking for answers.  Paul talked to new family members who said they’re concerned about some of the conditions they’ve witnessed there.

Before this investigation, two lawsuits were filed on behalf of residents who are now deceased. The suits alleged sexual assault, poor treatment and untimely death.

According to Nursing Home Compare on the Medicare website cms.gov, Lake Park is a one-star facility owned and operated by PRINCIPLE LONG TERM CARE, INC tha tis on the Special Focus facility watch list. On January 15, 2016, the facility was fined $132, 600 and then again on November 2, 2016 for $277,052.

Sexual assaults are among the most severe cases against residents of nursing homes. However, it is also the least detected, reported, and acknowledged type of problem in this institution.  The University Herald reported on a new study that found sexual assault is prevalent in nursing homes. However, this issue has been very under-reported to the point of being ignored.  The study observed 15 past studies in peer-reviewed journals that focus on the topic of sexual assaults on nursing home residents.

Moreover, white females suffering mental and physical conditions are more likely to be victims, since they are the most vulnerable. The study, published in “The Gerontologist” found that these sexual assaults happen because legal examinations aren’t done regularly due to administration complexities, Eureka Alert reported. Training and institutional policy in these nursing homes are also major problems that propagate the cases of sexual assaults. Ultimately, nursing homes are not equipped adequately to stop these sexual assaults.

 

The study suggests that nursing home staff should have more training to help them identify and handle these sexual assault cases. The study’s authors said there is a gap in knowledge about sexual assaults, which is why staff should be trained.

According to Monash University’s Daisy Smith, who is also the lead author, there is a lot more that is needed to be done for those that are most vulnerable in these nursing homes. Regulatory investigative personal doesn’t have the right resources to properly identify and handle these cases of sexual assaults in nursing homes, said Smith.

The Healthcare Finance News reported the settlement between Prestige Healthcare and the U.S. Department of Justice.  Based in Louisville, Kentucky, Prestige is an owner and operator of nursing homes in several states.  Prestige Healthcare has agreed to pay the federal government nearly $1 million to resolve allegations that it violated the False Claims Act in a scheme to falsely bill Medicare for unnecessary genetic testing, according to the U.S. Department of Justice.

Nursing home operators such as Prestige place orders with clinical laboratories for medically necessary diagnostic laboratory tests for their residents. In order to be considered medically necessary and thus reimbursable under Medicare, the laboratory test must be ordered by the physician treating the resident.

The allegations charge Prestige with failing to ensure that physician orders were obtained for the genetic testing prior to its being conducted, and that Prestige physicians were not aware of, and did not agree with, the medical necessity of the testing.

The United States alleged that in 2014 Prestige was approached by an entity known as Genomix, which claimed that it could perform genetic testing on Prestige’s Medicare residents in order to ascertain whether those patients were properly metabolizing their medications. The federal government alleged that in 2014 and 2015, Prestige provided Genomix with insurance and personal medical information, as well as access to patients in nursing homes in several states for purposes of conducting the testing. Genomix conducted the testing by taking cheek swabs of each Prestige patient and then sending the cheek swab to a laboratory for analysis.

Prestige failed to ensure that its patients were informed of the testing prior to its being conducted, and provided with the opportunity to decline the testing.

The DOJ said the lack of physician orders and patient consent was discovered during a survey conducted by state regulators in late 2015.

 

When CNN published a report revealing widespread sexual abuse and assault in nursing homes, many people asked the same question: Why isn’t more being done to stop it?

The multi-part investigation revealed disturbing cases of rape and sexual abuse by nursing assistants and found that more than 1,000 nursing homes had been cited for mishandling suspected cases of sexual abuse.
In response, the National Association of Health Care Assistants pledged to take action. The organization said it was “saddened and sickened by the CNN investigative report” and that it planned to immediately ramp up its education and training efforts. It said it especially wants to ensure that nursing assistants know how to spot potential abuse and report it promptly.
But federal legislation introduced two days after CNN’s investigation was published could make it far more difficult to hold problematic nursing homes accountable for abuse, according to elder abuse attorneys. The bill, submitted by Rep. Steve King, R-Iowa, would limit the legal liability of nursing homes, among a wide variety of other doctors, medical facilities and companies.

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.