The Clarion Ledger reported the $1.25 million settlement between U.S. Department of Justice and Hyperion for allegations of false Medicare and Medicaid claims for  “grossly substandard care” at a Lumberton nursing home.  The government alleges that from October 2005 to May 2012, Hyperion made claims to Medicare and Medicaid for providing effectively worthless services to the nursing home residents.  The poor quality care caused the facility’s residents to suffer pressure ulcers, falls, dehydration and malnutrition, among other physical, mental and emotional harms, the government says.

Hyperion Foundation, a Georgia not-for-profit entity (Hyperion), Julie Mittleider, Hyperion’s former president, AltaCare Corp., a Georgia corporation engaged in nursing home management, Douglas Mittleider, AltaCare’s chief executive officer,  Long Term Care Services Inc. and Sentry Healthcare Acquirors Inc., and others have agreed to pay the settlement for alleged substandard care to residents at the Oxford Health and Rehabilitation nursing home in Lumberton. The nursing home was operated from late 2005 through mid-2012 by AltaCare, under a contract with Hyperion.

For example, the United States alleges that Hyperion failed to meet the nutritional needs of residents, failed to administer medications to residents as prescribed by their physicians, over-medicated residents, hired insufficient staff to care for them and diverted Medicare and Medicaid funds to other entities affiliated with Douglas or Julie Mittleider, leaving the facility unable to pay for its basic operations, including food, heat, air conditioning, pest control and cleaning. 

“When operators of nursing homes harm our most vulnerable citizens and break the law by defrauding our government for grossly substandard or worthless services, we will bring to bear all the resources of the federal Government in order to rectify these terrible actions,” Southern District of Mississippi U.S. Attorney Mike Hurst said in the news release. “I commend our attorneys and investigators for resolving this travesty with one of the largest healthcare fraud settlements involving a single nursing home. We will continue the Department of Justice’s long-standing commitment to protecting the elderly.”

The lawsuit was filed under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the government for the submission of false claims and share in any recovery.  The False Claims Act authorizes the United States to intervene and take over primary responsibility for the action, as it did in this case.  The amount to be recovered by the private whistleblower has not been determined.

St. Louis Today reported that infamous and disgraced nursing home company CEO Johnnie Mac Sells admitted stealing more than $667,000 from Medicaid and been sentenced to 41 months in federal prison.  Now , he also admits to stealing from employees’ 401(k) accounts and health benefit plans, although he may face no more time in prison.

Sells waived indictment by a grand jury and pleaded guilty in U.S. District Court to two counts: stealing from an employee benefit plan and stealing from a health care benefit program.

 Assistant U.S. Attorney Dorothy McMurtry told U.S. District Judge Henry Autrey that money for their 401(k) plans was withheld from Legacy Health Systems employees’ pay from August to October 2016, but was not added to their accounts. Employees didn’t know because Sells failed to file annual reports, she said.  She also said that there was more than $800,000 in the plan in December 2015, and nothing 15 or 16 months later.
 McMurtry said that the employee health care plan was terminated in May 2016 for nonpayment, but Sells continued to withhold a total of $20,000 from employee paychecks. Those employees only found out they didn’t have health insurance when their health claims were rejected, she said. McMurtry said there was more than $124,000 of unpaid health claims.

Legacy Health, the Sells family business, once employed 1,600 who cared for 2,000 patients in 27 facilities across Missouri, Kentucky and Tennessee.  But by 2016, there were only three nursing homes left. And patients in Benchmark Healthcare were going hungry while Sells spent Medicaid money on strippers, gambling, pet care and country club fees, prosecutors have said.

A Post-Dispatch investigation documented the company’s fall.

WALB reported the complaints about the horrific conditions at Pinewood Nursing Home.  Virginia Toombs said her brother was living in horrible conditions at the nursing home during the last year of his life.  “It was the most disgusting thing I’ve seen in my whole life,” said Toombs.  “I’m glad he’s in heaven. I prefer him to be in heaven than in that place any day,” said Toombs.

Roaches everywhere, a sight that will make will make your skin itch.  “Everywhere I tried to sit in the room with my brother who was dying. They were in the bed. My brother was on an oxygen machine and they were crawling on the oxygen machine,” said Toombs.

Toombs said she brought it to the attention of some of the staff there who said they were already aware of the issue.

“I said, ‘This is disgusting. How can you all even work here?'” said Toombs.

The facility has a 1-star overall rating.

In August of 2015, the Federal Department of Health and Human Services and Centers for Medicare and Medicaid Services listed on its inspection report that the pest control company revealed to the inspector that the bill was not paid from July 2015 to December 2015 with a total of $1,313.00 owed to the pest control company.

Live roaches were found in two rooms, and dead roaches were found in the conference room.

In the most recent inspection completed five months ago, it details a much bigger problem.

They found bugs on a variety of surfaces on the walls, bulletin boards, and behind toilets.

The pest problem also mentioned rats.

The inspection report details that ‘The administrator revealed that the pest control company comes to the facility on a monthly and as-needed basis. She stated to the inspector that she felt as if the pest control program was effective.’

“Your parents in their last days or your family members they need to be in the best of care in their last days and not in a facility where their health is already bad and being infested by roaches and rats just makes it worse,” said Toombs.

When we reached out to the facility, their administrator gave us a statement saying “We are not aware of a pest control problem. We have pest control come twice a month. Any issues in the inspections have been taken care of.”

 

Forbes reported on Omega Healthcare Investors (OHI) which has long been a popular choice for income advisors. The real estate investment trust focuses on nursing homes and health care facilities–sectors that benefit from an aging population.  Based in Hunt Valley, Maryland, Omega is a real estate investment trust that provides financing and capital to the long-term health care industry, especially skilled nursing facilities.  The company owns or holds mortgages on more than 900 assisted living facilities, nursing homes and specialty hospitals in the United States and Britain. Omega recently announced the acquisition of 15 skilled nursing facilities in Indiana, which will make it the nation’s largest owner of post-acute-care centers.

Omega Healthcare Industries just raised its dividend for the 21st straight quarter.  The stock now pays an amazing 9%. This is only the third time in the last ten years that Omega Healthcare has paid this much.

Overall, the big picture for skilled nursing facility demand looks great. The industry, which is actually seeing supply decrease as demand increases, is projected to be in a supply deficit within the decade.  Total patient days at skilled nursing facilities are increasing, and are projected to accelerate higher in the coming years.

U.S. News had an interesting article discussing how Louisiana‘s payments to private nursing homes for taking care of Medicaid patients have risen substantially over the last decade increasing profits even as their occupancy rates stayed flat, according to an audit.  The state Medicaid program spent $8.7 billion in federal and state dollars on nursing home care for people who are elderly or disabled from 2006 through 2016, as daily rates paid to about 260 nursing homes increased 54 percent from $112.34 to $172.82.  In the last budget year that ended June 30, Medicaid payments to the facilities reached $1 billion.  Occupancy rates over the same period, however, “have generally remained the same,” growing by less than 1 percent.

One easy explanation is that the nursing home industry is powerful and a hefty campaign contributor at the state capitol.  In fact, inadequate monitoring and enforcement caused the department to fail to recoup $3.2 million in Medicaid payments for ineligible patients in 2014.

 “Even with the increasing payments to nursing facilities, Louisiana continues to rank poorly in regards to quality of care,” auditors wrote.
 Auditors also said the Louisiana Department of Health needs to improve its oversight of payments to ensure they’re accurate. They said the agency should issue penalties for late cost reports from nursing homes and tougher sanctions for facilities that have repeat audit violations.

Ashton Place Health and Rehabilitation Center nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.  A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

The 98-page inspection report cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.  According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

The fines totaling $50,000 were imposed on the 211-bed nursing home.  In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a rare freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

 The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.  What is worse?  Knowing of a problem and ignoring it or not even being aware of what is going on at the facility?

See article at Commercial Appeal.

The Department of Justice announced four San Diego-area nursing homes owned by Los Angeles-based Brius Management Co. have agreed to pay at least $6.9 million to resolve allegations that their employees paid kickbacks for patient referrals and submitted fraudulent bills to government health care programs. The four nursing homes involved in the settlement are: Point Loma Convalescent Hospital, Brighton Place – San Diego, Brighton Place – Spring Valley, and Amaya Springs Health Care Center in Spring Valley.  The settlement resolves an investigation into allegations that their employees paid kickbacks to discharge planners at Scripps Mercy Hospital San Diego to induce patient referrals to the nursing homes in violation of the federal Anti-Kickback Statute.

“Kickbacks for patient referrals are illegal under federal law because of the corrupting influence on our nation’s healthcare system,” said Acting United States Attorney Sandra R. Brown. “This settlement demonstrates our resolve to combat fraud that compromises the care provided to patients served by a government healthcare plan. This case further shows the power of whistleblowers to shine a light on corrupt activities and obtain significant recoveries on behalf of United States taxpayers.”

The investigation examined additional allegations made in a “whistleblower” lawsuit that the nursing homes submitted false claims to Medicare and Medi-Cal for services provided to patients referred from Scripps Mercy Hospital. Bills submitted for patients referred as a result of illegal kickbacks would constitute fraud against the United States and the State of California.

The settlement resolves a lawsuit brought by a former employee of one of the nursing homes under the qui tam – or whistleblower – provisions of the federal and state False Claims Acts, which allow private citizens to file lawsuits on behalf of the United States and California and share in any recovery. The whistleblower, Viki Bell-Manako, will receive 20 percent of each settlement payment. Pursuant to the settlement, United States District Judge John F. Walter today dismissed the lawsuit, United States of America, State of California ex rel. Bell-Manako v. Brius Management Co., et al., CV11-2036-JFW.

Nursing home employees conspired to pay kickbacks allegedly without the knowledge of Brius Management Co. The nursing homes admitted that their employees used corporate credit cards to pay for gift cards, massages, tickets to sporting events, and a cruise on the Inspiration Hornblower that were given to planners at Scripps Mercy Hospital as kickbacks.

“Skilled nursing facilities that pay kickbacks in order to boost profits will be held accountable for their improper conduct,” said Christian J. Schrank, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General. “We will continue to crack down on kickback arrangements, which can corrupt medical decision-making and undermine the public’s trust in the health care system.”

 

 

WFLA had an article about the horrific neglect and abuse suffered by Willie Johnson at the hands of the caregivers at Habana Health Care Center owned and operated by Consulate Health Care. His daughter Tonya Baker said her elderly father is living in poor conditions and shared photos to prove it.  “Not taking care of my dad, not feeding my dad, going in there finding my dad, wet Pampers, Depends, not being changed,” she said.

johnson 2

“My daddy’s not getting the care that he’s paying for to stay in that facility,” Baker told me.  Baker has filed five complaints with the State’s Agency for Health Care Administration about the nursing home. Four out of five times, they found the nursing home violated its own rules or law. But despite the state’s involvement, Baker says problems persist.

“I also went in there and had them take my daddy’s air conditioning out the wall because he had a lot of mold in there, in the air conditioner and in the air conditioner wall,” explained Baker.

The photos include one where he has a busted lip. Baker said the facility told her he was punched by a roommate. Another photo shows her father with a gash on his forehead after a fall in the shower.

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Nationwide, eviction is the leading complaint about nursing homes. In California last year, more than 1,500 nursing home residents complained that they were discharged involuntarily. That’s an increase of 73 percent since 2011.  NPR reports on AARP’s lawsuit against the illegal practice.  Nursing home residents have a lot of rights guaranteed in state and federal law. For example, they have to be given 30 days’ notice before they’re moved involuntarily. And the nursing home has to hold their bed for a week if they’re in the hospital.

The legal wing of the AARP Foundation asked the federal government to open a civil rights investigation into the way California deals with nursing home evictions. Now, they’re suing Pioneer House and its parent company. It’s the first time the AARP has taken a legal case dealing with nursing home eviction.

The California Long-Term Care Ombudsman Association joined the lawsuit as a co-plaintiff. The organization represents long-term-care ombudsmen. Those are the public officials who track complaints about nursing homes and advocate for residents. But Leza Coleman, the group’s executive director, says the spike in complaints about evictions is so overwhelming, that it’s “impacting our ability to handle other complaints.”

The Pittsburgh Post-Gazette reported the tragic and preventable death of Pittsburgh businessman Robert Frankel who died from asphyxiation from an incident in which his neck was trapped in bed rails.  Mr. Frankel died late Sept. 17 at the nursing home from what the medical examiner deemed at the time accidental asphyxiation, “due to compression of the neck.” The Charles Morris Nursing and Rehabilitation Center has discontinued using such railings in response, according to a Pennsylvania Department of Health report.

“Based on review of facility policy and documentation, clinical records and staff interview, it was determined that the facility failed to identify a hazard created by the use of side rails resulting in the death,” the report said.   The report said that at 11:30 pm. on Sept. 17, “a nurse aide was performing first rounds to check on the residents and found Resident R1 (Health Department inspection reports do not identify individuals by name) pulseless and without respirations, lying with his body on the floor and his neck between the air mattress and the side rail.” A nursing supervisor pronounced him dead at 11:40.