Law360 had an interesting article about the Trump Administration decision to ignore requests for public information about nursing homes.  At least four lawsuits have been filed in federal courts since early April accusing CMS of wrongly impeding access to various records. The allegations include improper redactions and charging of excessive fees in violation of the Freedom of Information Act.

Abuse and neglect in the nation’s 16,000 nursing homes is a widely recognized problem. Two years ago, the U.S. Department of Justice launched 10 task forces targeting “grossly substandard care” in nursing homes. Last year, a federal watchdog urged CMS to take “immediate action” to address the underreporting of physical and sexual abuse in the nation’s nursing homes.

“The Trump administration is hindering plaintiffs attorneys who investigate abuse and neglect of seniors by heavily redacting nursing home records and charging tens of thousands of dollars to produce such records, according to interviews, government correspondence and newly filed lawsuits.”

This is clearly a decision to help the nursing home industry cover up neglect and avoid accountability.   Some of the recent litigation brought by plaintiffs attorneys is aimed at gathering evidence of the administration’s motivations. In a lawsuit filed last month, two plaintiffs attorneys — Ernest Tosh of Tosh Law Firm PLLC and David Marks of Marks Balette Giessel & Young PLLC — sought any communications between CMS and third parties concerning the disclosure of nursing home records.  The attorneys want those communications in order to determine “whether CMS’ reversal of its prior policy regarding disclosure … resulted from, or was influenced by, pressure from nursing home industry representatives or others acting at their behest,” according to the suit.

Another lawsuit that Tosh and Marks filed last month accuses CMS of excessively redacting nursing home records. According to the suit, the federal agency in July 2017 demanded $9,000 to produce records, and so Tosh requested a sample of the records to ensure that they would be worth the money.

“The redactions included in the sample provided to Tosh indicate that any records [CMS] does eventually produce will be unlawfully redacted and functionally useless,” the lawsuit says.

Steele’s lawsuit is aimed at forcing CMS to certify its own estimates of appropriate staffing levels in nursing homes. CMS employees usually cannot be subpoenaed to testify about the accuracy of those estimates, and so certifications are essential to using the estimates as evidence that nursing homes were understaffed when patients suffered harm.

“It’s literally the only way we can use this in court cases,” Steele said.  “I think there absolutely was some sort of directive that came down … to cut off the spigot of data,” Steele said. “Because this data’s getting used effectively to hold these nursing homes responsible for the way that they’re treating their residents.”

The cases are Johnson v. Centers for Medicare & Medicaid Services, case number 2:18-cv-00590, in the U.S. District Court for the Western District of Washington, The Steele Law Firm LLC v. U.S. Department of Health and Human Services et al., case number 4:18-cv-00275, in the U.S. District Court for the Western District of Missouri, and Tosh et al. v. U.S. Centers for Medicare & Medicaid Services et al., case numbers 1:18-cv-00915and 1:18-cv-00949, in the U.S. District Court for the District of Columbia.

 

Vox had an article about The Urban Institute’s plan to expand health insurance coverage: the Healthy America program.  The plan incorporates the existing system, especially the employer-based coverage that covers half of Americans, and offers a public option similar to Medicare and Medicaid to more people.

The article gives a great summary of the plan:

  • A new insurance market would feature private health plans and a public option.
  • Much of the Medicaid population would move into this new market: Children and the disabled would receive supplemental benefits to make sure they get the same level of coverage as they currently do, and the program would continue to cover long-term care separately.
  • The default plan would be more generous than the ACA’s: covering 80 percent of health care costs, compared to 70 percent. Lower-income people could also choose plans that cover an even higher share of their health care costs.
  • Premiums would be based on a sliding scale and more generous than Obamacare’s. People who make 138 percent of the federal poverty level or less ($27,000 for a family of three) would pay no premiums for that default plan, and premiums would rise slightly the more income a person makes. There would be no upper limit for subsidies as there is under the ACA: A family making more than 400 percent of the federal poverty level ($98,400), which is the current cut-off for assistance, would not have to pay more than 8.5 percent of their income on premiums for the default plan.
  • Rather than have an individual mandate, Americans would lose a share of their standard tax deduction if they were uninsured. The goal is to find a balance between the need to encourage healthier people to buy insurance while recognizing the unpopularity of the mandate, the Urban Institute researchers said.
  • Low-income people — those eligible for food stamps or cash welfare programs — would be automatically enrolled in an insurance plan if they are found to be uninsured.
  • Payments to health care providers under these Healthy America plans would be capped at Medicare rates.
  • Obamacare’s rules prohibiting preexisting conditions and requiring that certain essential health benefits be covered would remain.
  • Employer-based insurance, the traditional Medicare program, the Veterans Administration health care program, and the Indian Health Service would be left in place.

At the top level, there are several important features to this plan

  1. It would not disrupt the existing employer or Medicare populations. I think that is the first challenge for a universal single-payer plan, so the Urban plan seeks to avoid it — though the tradeoff is it will not achieve universal coverage.
  2. By combining the Medicaid population with the individual market, the Healthy America program would have a bigger customer base (and risk pool) than Obamacare currently does, which could help prevent some of the adverse selection that has driven up costs in the ACA. The caps on provider payments would also help keep costs down.
  3. Much of the program’s costs (another challenge for a truly universal health care system) would come from existing sources — Medicaid and the ACA in particular. But there would be a need for new funding: Urban suggests increasing an existing Medicare tax to raise about $800 billion over 10 years, which they think would cover much of the new costs.

The Urban Institute projected that if we swapped out Obamacare for Healthy America, the uninsured rate would drop from 10.9 percent to 6.7 percent in 2019. That would still leave 18.4 million Americans uninsured — a big flaw, I’m sure, in the eyes of people advocating for a truly universal health care program — but that is down from 34.3 million uninsured currently.

Slate had an interesting article arguing that ObamaCare was working until Trump’s sabotage of the health care plan.  New data shows that, in 2017, the market finally stabilized. For every dollar they collected in premiums last year, insurers paid out 82 cents on medical claims on average, according to a recent report by the Kaiser Family Foundation. That’s down from 96 cents in 2016 and $1.03 in 2015. “After several years, the remaining insurers figured out how to earn a profit in the individual insurance market,” Kaiser Senior Vice President Larry Levitt said.

Insurers adjusted their premiums high enough that insurers could finally make a profit, and would set the market up for much gentler, single-digit price increases in the future.  However, thanks to Donald Trump’s decision to stop paying key subsidies to insurers, premiums shot up once again this year. Early evidence suggests they’ll rise by double digits once again in 2019 in order for insurers to avoid losing money, largely because Republicans chose to repeal Obamacare’s individual mandate, which kept insurance prices down to some degree by requiring all adults to obtain coverage. Middle class families that don’t get financial help are going to take a hit, and many could be priced out of the market.

Again, this could have easily been avoided, had Republicans just left the law alone, instead of trying with every ounce of their power to wreck it. For a hot second, Obamacare was working roughly as intended. And now it’s broken again, and the uninsured rate and cost of health care is on the rise.

 

Shephard Spruill, the CEO of Carolina Support Services, has received a prison sentence in connection with a Medicaid fraud scheme in North and South Carolina.  A news release from the U.S. Department of Justice said Spruill was sentenced to eight years in prison followed by three years of supervised release.  According to prosecutors, he supplied hundreds of patient names to third parties who illegally billed millions in fictitious mental health services defrauding the U.S. taxpayers.

Prosecutors say Spruill has been ordered to pay nearly $6 million to the Medicaid programs in North and South Carolina, as well as to one of the individual victims. He also has to forfeit nearly $1 million in criminal proceeds and is banned from Medicaid for life.

“Do not for a moment believe that we have given a pass to those who steal from taxpayers through fraud,” Higdon said. “This case shows our continuing resolve to bring all to justice, even CEOs who commit their crimes with lies instead of guns.”

 

PennLive reported the settlement involving Maple Farm Nursing Center and the family of a resident who was sexually assaulted by a fellow resident. The parties agreed to resolve the case for $6.75 million.  A jury had awarded $7.5 million to the family, and the home and its insurance carrier agreed to the lower settlement rather than appealing, said the report.

The suit was filed against the home and Glenn Hershey, who was convicted in 2014 with sexually assaulting the woman in the home in January 2013. He is serving a state prison sentence of 8-20 years.  The lawsuit claimed the home failed to ensure that Hershey, who was a registered sex offender, didn’t come in contact with the woman.

The Island Packett reported the investigation into an alleged sexual assault at a Hilton Head nursing home is continuing, according to Beaufort County Sheriff’s Office spokesperson Capt. Bob Bromage.  Bromage said previously a suspect in the assault has been identified as a nursing home employee.  The resident at the Life Care Center of Hilton Head informed a nurse she had been assaulted overnight. The center reported the incident to the sheriff’s office and the South Carolina Department of Health and Environmental Control.

DHEC said in an email it received an incident report of sexual assault from Life Care on May 2, 2018, according to Adrianna Bradley, DHEC spokesperson.  If you suspect someone has been treated improperly at a healthcare facility in South Carolina, complaints can be filed online, or by calling 803-545-4370, according to Bradley.

The Centers for Medicare & Medicaid Services recently rejected a proposal from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. Arizona, Utah, Maine and Wisconsin have also requested lifetime limits on Medicaid.  Since Medicaid began in 1965, no state has restricted how long beneficiaries could remain in the entitlement program.

 This was the first time the Trump administration has rejected a state’s Medicaid waiver request regarding who is eligible for the program.  CMS has approved work requirements for adults in four states —New Hampshire, Kentucky, Indiana and Arkansas.

All these states expanded Medicaid under the Affordable Care Act to cover everyone with incomes of more than 138% of the federal poverty level ($16,753 for an individual). The work requirements would apply only to adults added through that ACA expansion.

 

ABC6OnyourSide had an article about three nursing home employees indicted on charges that include involuntary manslaughter, forgery and gross patient neglect in the Jan. 7 death of 76-year-old Phyllis Campbell.  The three employees at Hilty Memorial Nursing Home in Pandora were on duty when a nursing home resident wandered off and died of hypothermia in January.

A state investigation found that Campbell left the facility around 12:30 a.m. Jan. 7 through a courtyard door equipped with an alarm. A device she wore apparently failed to alert workers. The low temperature that night was zero degrees.

 

 

The Journal-News reported on the rape of a nursing home resident by a mentally incompetent resident.  Gary Eugene Earls, who has limited mental capacity, was arrested by police after a incident at Close to Home.  Earls was indicted by a Butler County grand jury on two counts of rape in December.  Earls admitted to physically penetrating the 95-year-old woman during the early morning hours of Nov. 17. He said he went into the woman’s room and pulled down his pants. The woman was naked, Earls said.  The 95-year-old woman died just weeks after the incident. She suffered from dementia but was alert.

Prosecutors fought to keep control of the case to ensure Earls would not be placed in a facility where he could potentially assault another person. The issue surrounding what to do with Earls was “a black hole of the justice system,” Butler County Prosecutor Michael Gmoser said.

“(The judge) ultimately has to make a determination that the evidence established that he committed the acts to constitute the criminal offense,” Gmoser said. “It is also a serious offense and the public has an interest in respect to public safety … the state is asking for her to approve his commitment to a mental facility equipped to handle these type of offenders.”

The rapist was committed to a psychological facility, Summit Behavioral Health, a facility for mentally ill adults.  In addition to the cognitive problems, Earls has a history of alcohol and drug abuse.

 

 

Authorities are investigating the strangulation death of 75-year-old Rebecca Eudy, who was found April 5 at Open Fields Assisted Living in Tarboro.  Open Fields is an adult care facility, which houses the elderly and also some people with severe and persistent mental illness.

No arrests have been made yet.  Her death certificate says Eudy asphyxiated and suffered traumatic injuries to her neck.  Eudy was charged with assault in December after a fight with a 46-year-old man living at Open Fields who allegedly exposed himself to her.

Eudy’s daughter has filed a complaint with the state Department of Health and Human Services after learning that her mother’s death was being treated as a homicide.