A Florida federal jury in U.S. ex rel. Ruckh v. Genoa Healthcare, LLC, found the operators of 53 skilled nursing facilities liable for more than $115 million in damages stemming from false claims they submitted to Medicare and Medicaid after pretending patients needed and received more care than they did.

The jury ruled on False Claims Act allegations brought by whistleblower Angela Ruckh, who worked at two of the facilities as a nurse, and found that the four defendants — CMC II LLC, Salus Rehabilitation LLC, 207 Marshall Drive Operations LLC and 803 Oak Street Operations, LLC were liable for false claims.

Ruckh said she saw years of corporate scheming meant to “bill Medicare and Medicaid” by upcoding therapies.  Angela Ruckh, formerly of La Vie Management, proved that the providers listed in the case presented “false or fraudulent” claims for reimbursement.

The Government has many tools to help it prosecute False Claims Act cases.  One such tool is extrapolation—the act of using a sample of resident files to determine an error rate and applying that error rate to a greater universe of resident files.  After some initial setbacks including having their case dismissed for lack of necessary detail, the plaintiff complained that to show fraud with detail in every instance was not feasible.  The plaintiff instead asked to use the Government’s tool of extrapolation (to be able to have an expert pick out some files, determine an error rate and apply that error rate to a larger universe.)  The Federal Government filed a brief in support of permitting private parties this power.

The Court sided with the whistleblower, allowing her to use extrapolation and statistical sampling to estimate the volume of overpayments allegedly received by the defendants.  In issuing his decision, District Judge Steven Merryday relied on other cases that accepted statistical sampling methods as reliable and acceptable evidence in determining facts related to False Claims Act claims.  Judge Merryday echoed a recent District Court case in Tennessee that considered “the large universe of allegedly false claims” in finding that “it would be impracticable for the Court to review each claim individually” and to do so “would consume an unacceptable portion of the Court’s limited resources.”

Though this case is just the latest in a string of cases upholding the use of statistics and extrapolation to establish liability under the False Claims Act, this decision is unique in that it allows an individual qui tam whistleblower to utilize this powerful tool to demonstrate falsity even where the Government has declined to intervene in the case.

The Tuscaloosa News reported the arrest of Betty Jean Tubbs who was charged with elder abuse for punching a resident in the face while working at Heritage Health Care and Rehab. Tubbs was a certified nursing assistant at the facility.

She is accused of striking a resident, 71, on the head and punching the resident, causing eye swelling and bruising.

A grand jury reviewed evidence and indicted Tubbs on the felony charge on Jan. 24. She was arrested Feb. 16 and later released on bond.

If convicted, Tubbs could be sentenced to two to 20 years in prison and a fine up to $30,000.

 

CNN had a heartbreaking article written by Bobbi Young about the rape her mother suffered at a nursing home.

I scanned my mother’s bed, pulled back the rumpled sheets and uncovered her shivering naked body. I stared at her bruised inner thighs, her sheets wet with urine and blood, her catheter pulled completely out of her. I covered her with a blanket and held her close as she pleaded, “Get me out of here.”

I kissed her forehead, our tears mixing, and promised no one was going to stop me. She would not spend another night in this nursing home.
I pushed the call button. No response. I followed the cord to the wall and found it disconnected. My heart racing, I tracked down an aide and demanded that a nurse come to my mother’s room immediately. At 88, she was examined with nonchalance and covered back up.
I called the manager to her room and told her I was taking Mom home.
The nursing staff gathered in force, attempting to convince me that her release was a long process, that my mother could still benefit from their help. Her stay in the nursing home had been a temporary transition needed after being hospitalized with a stroke.
But I knew my mother had been harmed. I feared the worse. And I feared for her life if she stayed there.
I called her doctor to sign a release form, and I phoned a service for private medical transport. I also called my husband and said, “I need to bring Mom home with us today. Go get Daddy.”
At the front door of the nursing home, the management staff lined up to wish us well. They invited us to come back and visit.
“Thank you,” I told them, “but we will never drive by this road again.”
When we arrived home, the driver unloaded my bundled mother and the rain momentarily stopped. I looked up and saw my father, his hand pressed to the window, tears in his eyes and mouthing the words “Mama … Mama’s home.” Married 69 years, my parents experienced every second apart as an eternity.
Once settled in their own bed, Daddy curled up next to Mother, held her hand, prayed with her, assured her she was OK now, home safe. She was still recovering from her stroke, and even though my father sensed some harm had come to her, he didn’t ask. He didn’t want to stress her more. He never left her side.
Over the weeks that followed, my mother complained of pain in her groin area. Doctors increased the doses of pain medication, but she still awoke in anguish, day after day. I finally had to examine her — and my heart sank.
I knew she needed to be seen by her gynecologist as soon as possible.
A nurse practitioner examined my mother and ran tests to confirm her suspicions: a sexually transmitted disease. Had my mother shown these symptoms before, she asked. The answer was no. Had my mother had any sexual partners besides my father in her lifetime? The answer was no.
When I told her about what had happened in the nursing home, the nurse said my father would need to be tested for the disease. My mother was visibly shaken. I asked the nurse, if my father was negative, what would be the next step? She said, you need to call the California Department of Public Health and file a report.
We drove home silently. My mind struggled with how much my mother had been through; now we were minutes away from devastating my father. I asked if she wanted my help in telling Daddy. The answer was yes.
As I spoke, Daddy didn’t hesitate to agree to be tested. Then he asked what all of this meant. What would proving he was negative for the disease mean?
Mama, her voice choked with sadness, replied: “I was raped.”
My father held my mother, crying, shaking his head in disbelief and apologizing for not being able to keep her safe.
I grew up believing my parents were strong and took comfort trusting I would always be safe. They both worked two or three jobs throughout my childhood to buy me and my siblings encyclopedias to enhance our knowledge of the world long before Google existed.
Witnessing this wound inflicted on my parents cut deeply to the core of my own foundation. The hospital had recommended the nursing home as a transitional step; her own internist was the director of the facility: What could possibly go wrong?
There were no warning flags. We failed to protect her against something we could not even imagine existed. A distress signal is only as good as the person who sees it. When I saw it, I took action. But it was too late.
For months, my parents comforted each other, not wanting to be even a foot apart. Their love never wavered; it only deepened. I would walk past their bedroom and see them snuggled tightly together, whispering. My father later told me they were praying and planning to renew their wedding vows on their 70th anniversary.
Beyond the harm the perpetrator had inflicted on my mother, he took a toll on my father’s remaining strength and stole some of the precious time my parents had left. Still, together they decided to fight for reform, which my husband and I fully supported. We filed a civil lawsuit against the facility, arguing that more should have been done to protect my mother. She was brave enough to appear at the center of a public service video created by a nonprofit calling for nursing home reform.
On the day my father died, my husband was diagnosed with terminal cancer. His painful journey ended 17 months later. But our commitment to choose love and joy enabled Mother and I to embrace our faith and carry on. I promised my husband I would not be sad or bitter. I had promised my father I would care for Mama and keep her safe.
I feared that I would not be able to fulfill those promises.
But there are moments in life that transcend fear. They mend twisted hearts. This became one of those moments.
After my husband’s funeral, all of my mother’s nurturing traits intensified. I had promised to care for her, and now she was providing me with what felt like a second childhood. She took the reins, suggesting remedies such as extra locks on doors and an alarm system to quiet our fears. She reminded me of recipes to help stretch our dollars to survive — such as making “imagination cookies.” When I looked sad, she would talk about funny things my husband did to make her laugh. We prayed together, planned our spring garden, went for drives on hot days with the windows down, hair blowing in the wind, laughing with memories.
I promised my mother I would honor her vow to carry on her courageous battle for justice all the days of my life by telling her story. While her perpetrator will likely never be found, it was one of her last wishes for people to understand that no one is too old to become a victim of rape.
My mother died in January. She was 94. As I walk around my home now, I look at the empty rocking chair in which she soothed her children. I can feel her brushing my long hair. The seedlings she planted in eggshells on Christmas Day are bursting toward spring. I can hear her laughter and her reminder to me: “The gifts God gave you, he did not give to another; respect them and share them wisely. …”
Who was this woman in my life? Why was she made to suffer so?
An answer fills my sorrowful heart:
Suffering can carve two types of people, monsters and angels. I am fortunate to have been raised by angels. And I pray to one day be worthy of that divine fabric that still holds me tightly together — love.

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.

KSPR reported on a proposal to keep residents safe, and to deter theft, fraud, and abuse, by allowing video cameras in Missouri nursing homes.  Under the proposed law, families can choose to put a camera in their patient’s room, at their own expense and would be able to view the cameras at any time.

Supportive lawmakers say families could monitor how much and how often medications are given and how their loved one is being taken care of overall. Rep. Andrew McDaniel backs the bill after his staff says they received hundreds of complaints about abuse, neglect, rape and fraud.

Nursing home lobbyists claim they are concerned about patients’ privacy, and their lobbyists have killed similar bills in past legislative sessions. However, McDaniel says the camera can be turned off during baths or if a patient is exposed.

 

The Columbus Dispatch reported that Autumn Health Care of Zanesville, a nursing home operator, has been ordered to repay tens of thousands of fraudulently obtained Medicare and Medicaid dollars, after an investigation by the Ohio Attorney General’s Office. The investigation found that the owner and other employees habitually altered documents to make it appear patients were being properly cared for in order to receive government aid.

With permission from family members, investigators hid surveillance cameras in patients’ rooms, the first time such measures had been used in a state nursing-home investigation.  While the nursing home’s records reflected a high level of care, the investigation found that several patients missed treatments or were given therapy they didn’t need, the attorney general’s office said.

The corporation pleaded guilty to multiple charges in October, including forgery, tampering with evidence, Medicaid fraud, telecommunications fraud, theft and engaging in corrupt activity.

Autumn Health Care of Zanesville must pay back $53,390 to the Ohio Department of Medicaid and $75,250 to the federal Centers for Medicare and Medicaid, as well as $40,000 in investigative costs.

Its owner, Steven Hitchens, entered pleas to single counts of tampering with evidence, tampering with records and forgery. Hitchens was ordered to serve three years of community control and conduct 100 hours of community service.

 

 

 

A new study from researchers from Rowan University School of Osteopathic Medicine has found that delirium affects nearly 18 percent of nursing home residents and has a one-year mortality rate of 40 percent. The symptoms of delirium usually last one week, but can take weeks or months to resolve. The symptoms are similar to dementia, resulting in misdiagnosis in nursing home residents.

Delirium is a syndrome of altered mental status shown to produce disorganized thinking, deficits in attention and a fluctuating course, which plays a significant role in mortality of nursing home patients.  However, maintaining hydration and minimizing medication exposure is an effective means to prevent delirium. Pain can lead to delirium, and managing it well can improve outcomes.

The study was published in The Journal of the American Osteopathic Association.

Hall of Fame magazine reported on the abuse at Winters Park Nursing Home.  Minnie Graham is 98 year old and living in Winters nursing home in Texas. One day, she told her family that one of the staff abused her.  The family became suspicious and more concerned when they found black eyes and bruises on Minnie’s face. The nursing home caregivers said that Minnie had fallen out of her wheelchair several times.

The family set up a hidden camera to find out for themselves what was really going on.  What the family saw terrified them.

One of the Winters Park Nursing Home workers, who was identified as Brenna Tiller, was caught on camera, hitting Minnie. She was also cursing and mocking at the elderly woman. While Minnie was screaming in pain, Tiller sprayed water to her face and placed a towel on her mouth. The towel that Tiller put on Minnie’s mouth was the one she used to clean the old woman’s body.

Another worker, who goes by the name Louis, was also caught on camera hitting Minnie. He also punched the old woman.

Louis was arrested while Tiller was convicted for felony with 5 years of probation.

The Chicago Tribune reported that two social workers, Kenneth Allen and Olufunmibi Ogunyipe, allege they were fired from Burnham Healthcare now known as Bria of River Oaks nursing home after refusing to fabricate medical records related to incidents of patient abuse.  Some of their patient-abuse allegations were investigated separately by the Illinois Department of Public Health, which cited the facility for safety violations, records show.

The nursing home has withstood years of state citations for violence, patient neglect and filth. Last year it received $16.5 million from Medicaid and Medicare while reporting $1.38 million in profits.  Records show that some of those federal health-care dollars went to Weinfeld’s uncle, nursing home magnate Morris Esformes, whose son and close business partner, Philip Esformes, is being held without bond in a Miami federal detention cell on charges that he orchestrated a $1 billion Medicaid kickback scheme in Florida.

Allen alleges that a supervisor told him to falsify the medical chart of a female resident who was hospitalized in 2012 with facial bruises and black eyes. Allen believes the woman was beaten by a fellow resident, but he was told to write that she had fallen. A state inspection report later found that the facility failed to properly investigate her family’s complaint that she was assaulted.

Allen alleges that after he documented a resident’s rape complaint, a supervisor ripped Allen’s report out of the medical file and tore it up. The state health department inspection concluded the facility had failed to thoroughly investigate the sexual assault allegation and to notify authorities.

Ogunyipe alleges that, in the case of a 60-year-old resident who had repeatedly requested a discharge, a supervisor told him in 2013 to write up medical notes falsely stating that Ogunyipe had tried repeatedly to transfer the man but couldn’t find a program with an open bed. A state health department inspection cited the facility for failing to assist the resident’s request for a discharge.

Ogunyipe alleges that a supervisor tried to deceive state inspectors by removing disheveled residents who might trigger state scrutiny because they appeared neglected. A supervisor gave him $30 to $50 to take the residents out of the building, buy them cigarettes, feed them at a McDonald’s and claim they were going on a field trip, saying: “They can’t be in the building,” the suit states.

Ogunyipe said that the administration wanted to conceal residents with untrimmed hair and soiled clothes because “you would know that they were not being cared for.”

He witnessed fellow employees entice residents back to their rooms with a cigarette or snack, then punish them. “They would just close the door and — boom, boom, boom! Deal with the resident. Beat him up. Spit on his face and then walk out, close the door,” Ogunyipe said.  (A 2012 state inspection report said two residents alleged guards beat or roughed them up in separate incidents. The report says that at least one guard at the home was fired as a result.)