On April 15, the Department of Justice announced that it had reached a $41 million settlement with two Florida healthcare providers—a lab and a pain relief center, both subsidiaries of Surgery Partners—and two of its former executives over fraudulent billing claims because for half a decade patients suffered unnecessary urine drug tests solely for the purpose of getting reimbursements under Medicare and Medicaid.
However, on April 10, five days before that settlement was announced, another arm of the Trump Administration, the Department of Health and Human Services, gave Surgery Partners roughly $45 million total from the CARES bailout, per its filings with the Security and Exchange Commission.
The $41 million that Surgery Partners’ subsidiaries paid on April 15 to settle serious federal fraud allegations had been essentially erased the week earlier—all with taxpayer dollars.
“You have the federal government on the one hand accusing a company of cheating the government and then you have, [on] the other hand the government giving money to that same company,” says Philip Mattera, Research Director at Good Jobs First, a non-profit organization tracking recipients of CARES funds. “At the very least, it’s unseemly.”
It’s also not uncommon. Good Jobs First found dozens of health care providers and nursing homes that received bailout funds under the CARES Act after reaching settlements on federal fraud allegations within the last decade—some worth hundreds of millions of dollars.
William M. McSwain, U.S. Attorney for the Eastern District of Pennsylvania, called the allegations “the type of conduct that must be rooted out of our health-care system.” But even as the settlement was made public, HHS was propping up those same companies with taxpayor funds.
Nursing homes need to be a priority when personal protective equipment (PPE) is being distributed, and these facilities also need to be required to have a nurse on staff 24 hours a day.
“It’s absolutely critical to have registered nurses 24 hours a day in nursing homes,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, in Washington. “Right now, the only federal requirement is a registered nurse for 8 consecutive hours a day, but people get sick in the middle of the night.” Without a nurse on duty for nursing home workers to consult, “we’re not going to get good care for people,” she said. “It is way past time to have nurses in nursing homes.”
“The federal government, whose prompt response was so desperately needed, failed to surmount the challenge and make PPE a priority for nursing homes,” said Michael Wasserman, MD, a geriatrician and president of the California Association of Long Term Care Medicine. The nursing home industry “had the ability to leverage their assets to acquire PPE, but many chose to wait for a government response which didn’t happen … As a clinician, I don’t care who takes responsibility for the acquisition of PPE, but without PPE, COVID-19 cannot be stopped.”
Wasserman and Edelman were speaking at a roundtable hosted by the House Democratic Caucus Task Force on Aging and Families. Task force members also heard from Chris Brown, a certified nursing assistant working at a nursing home. “I find the work to be very rewarding but to be truthful, I face many challenges on the job, and many of these challenges existed before COVID-19,” said Brown. Brown said nursing home workers are being paid “poverty wages” and often don’t get sick leave. “If I become sick, how can I take care of somebody? And who will take care of me? I have to choose between having the lights on and protecting my health.”
Wasserman worried about nursing homes allegedly dumping vulnerable residents in order to make room for more profitable COVID-19 patients. “I was worried that this type of behavior could and would occur, so when the story came out, it didn’t surprise me,” he said. “The bad apples highlight a couple of fundamental problems in the industry …. Surveyors can only do so much after the fact; we need to work to prevent this type of behavior” from occurring in the first place.
In addition, “medical directors have been kept out of medical management and decision making. We need to make sure the medical director is fully engaged,” said Wasserman. They’re critically important because “unless you have clinical leadership in the building calling this out, the facilities manage to come up with reasons and excuses for why they’re doing it. We need to be calling it out and recognizing that staff and facilities are under tremendous financial pressure and that drives a lot of this type of behavior.”
A striking bipartisan consensus arose in the Senate Judiciary Committee last month on the fact that the Trump administration hasn’t done its part to assure businesses and schools on how they can open responsibly, leaving many unsure how to proceed and worried about the consequences if they get it wrong.
The committee focused primarily on the question of whether to give businesses immunity from lawsuits over COVID-19. That wouldn’t be a good idea. But luckily, the hearing unearthed the real remedy to reassure businesses that it’s safe to reopen: giving them clear federal rules that will protect both well-meaning business owners and the ability to hold bad actors accountable.
David Vladeck, a law professor at Georgetown University who once headed the Bureau of Consumer Protection in the Federal Trade Commission, testified to the Judiciary Committee that companies generally are not vulnerable to negligence lawsuits if they can show they reasonably followed government safety regulations. As a result, he said, “the best way to reduce liability is for agencies to step up and issue guidelines.”
Lindsey Graham, the South Carolina Republican who chairs the Senate Judiciary Committee, asked every witness in Tuesday’s hearing — a group that included advocates for business, labor, and academia — whether “the country would be better off” if OSHA issued industry-specific guidelines about how businesses should protect workers and customers. The witnesses all said yes. (The labor representatives added, however, that it also mattered whether anyone would enforce those rules.)
Given how easy it is to transmit the coronavirus, it would be hard for plaintiffs to definitively establish where they or a deceased family member caught COVID-19, let alone that it resulted from a business’s negligence. Even if someone wanted to try to make such a claim, many lawsuits would be blocked either by state laws that route injury complaints through the workers’ compensation insurance system or by employment agreements that require workers to go to arbitration rather than the courts.
It would be terrible for Congress to reduce the threat of lawsuits for employers in egregious situations. The prospect of being sued for negligence helps to hold companies accountable for public-health and safety regulations that the government can’t enforce through inspections alone.
The Trump administration has refused or declined to institute a comprehensive national framework for responding to COVID-19 including buying and disseminating virus tests. Dr. Anthony Fauci, the nation’s top infectious disease expert, again expressed alarm at the increasing rate of infections after the country continues to discover more than 50,000 new cases per day. Fauci warned that the country was still “knee-deep in the first wave” of the pandemic, as U.S. deaths passed 130,000 and cases neared three million.
As the United States passes three million cases, most cities and states are still struggling with testing. Sites in New Orleans have run out of tests five minutes after doors open. In Phoenix, where temperatures have topped 100 degrees, residents have waited in cars for as long as eight hours to get tested.
America’s health care workers are dying; medical personnel account for as many as 20% of known coronavirus cases in many places. “Lost on the Frontline,” a collaboration between KHN and The Guardian, has identified 765 such workers who likely died of COVID-19 after helping patients during the pandemic.
As much as $273 million in federal coronavirus aid was awarded to more than 100 companies that are owned or operated by major donors to President Donald Trump’s election efforts, according to an Associated Press analysis of federal data. Many were among the first to be approved for a loan in early April, when the administration was struggling to launch the lending program. Churches connected to President Donald Trump and other organizations linked to current or former Trump evangelical advisers received at least $17.3 million in loans from a federal rescue package designed to aid small businesses during the coronavirus pandemic. Those receiving loans include City of Destiny, the Florida church that Trump’s personal pastor and White House faith adviser Paula White-Cain calls home, and First Baptist Dallas, led by Trump ally and senior pastor Robert Jeffress. City of Destiny got between $150,000 and $350,000 from the Paycheck Protection Program, or PPP, and First Baptist Dallas got between $2 million and $5 million, according to data released by the Treasury Department on Monday. Nearly 90,000 companies in the program took the aid without promising on their applications they would rehire workers or create jobs.
The video of a nursing home resident punching his roommate taken inside the Westwood Nursing center in Detroit has increased the push for video monitoring in nursing homes. The 75-year-old man is recovering after the assault from 20-year-old Jadon Hayden. Michigan Senator Jim Runestad is now preparing a petition calling for nursing homes to allow patients to install cameras in their rooms, it is what he says – right now only five other states allow. Runestad says Senate Bill 77 would establish that a nursing home patient – their family or advocate – would be allowed to monitor their own private room with a camera – under certain conditions… essentially the family would pay for and oversee the cameras.
“It’s just unbelievable how often this happens across the country and our state,” he said.
“This is a huge, huge problem,” said Sen. Jim Runestad (R-White Lake). Senator wants bill for video cameras inside nursing home room for senior safety, “I have literally watched dozens, hundreds, maybe thousands of videos (like) that online,” said Runestad.
Runestad says at the very least, allowing cameras inside patients’ rooms would deter bad or neglectful behavior and at the very best, give families some assurance that their loved one is getting the care they need.
“You have to require these nursing homes to allow the family to put the camera in,” he said.
“What we have now I believe is going to solve 90 percent of the problems if we get this passed,” he said.
The U.S. death toll from the coronavirus pandemic exceeds 130,000, as surging infection rates in the country overstretch hospitals. The U.S. is adding more than 50,000 new cases every day. Officials in states with surging coronavirus cases issued dire warnings and blamed outbreaks on reopenings as the weekly average for daily new cases in the United States reached a record high for the 27th straight day.
At least 60,000 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities for older adults in the United States. The virus has infected more than 300,000 people at some 12,000 facilities. Covid-19, the disease caused by the coronavirus, is known to be particularly lethal to adults in their 60s and older who have underlying health conditions. In 24 states, the number of residents and workers who have died accounts for either half or more than half of all deaths from the virus.
While 11 percent of America’s cases are in nursing homes, deaths account for more than 43 percent of fatalities.
Infected people linked to nursing homes also die at a higher rate than the general population. The median case fatality rate — the number of deaths divided by the number of cases — is 17 percent, significantly higher than the 5 percent case fatality rate nationwide.
Some states, including South Carolina, regularly release cumulative data on cases and deaths at specific facilities.
Trump continues to dismiss the severity of the coronavirus pandemic in the United States, downplaying the impact of the disease and saying “99 percent” of the positive cases were “totally harmless.” His flippant remarks about a virus that has already claimed 130,000 lives is shocking and perplexing.
Congress launched an investigation into the ongoing COVID-19 crisis in nursing homes, requesting information from both the federal government and five national for-profit operators in the industry. The action comes after the subcommittee held a hearing on COVID-19 in nursing homes in which both frontline workers and academics described the problem as systemic. The probe focuses on five major nursing home owner/operators: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare. (Data indicates over 500 deaths of caregivers and residents at SavaSeniorCare facilities, including in one facility where 98 percent of residents were infected).
“The only thing COVID did was rip the doors open,” Chris Brown, a CNA working in Chicago, said during the hearing, testifying that staffing and PPE shortages were a problem in nursing homes prior to the pandemic. “It blasted the doors open of a system that was already failing.”
Atlanta-based SavaSeniorCare is targeted in the congressional investigation because of their long history of problems including a pending Medicare Fraud case in Tennessee. Rubin Schron expanded his interests with the $1.3 billion acquisition of about 175 nursing homes from Mariner Health Care, Inc., which were subsequently leased to and operated by SavaSeniorCare. SAVA operates 209 SNFs and five ALFs in 21 states with a total of 24,908 beds as of December 31, 2017, making it one of the largest SNF operators in the United States. Mr. Schron effectively owns most of the equity in Sava through Cammeby’s outstanding loans to Sava.
The former Mariner properties are master leased to SAVA subsidiaries and each property, in turn, is subleased to separate entities, subject to an operating lease. After Tony Oglesby’s sudden death, Jerry Roles took over as the CEO of SAVA. The rest of the management team includes Tim Schindler (President and Chief Operating Officer since May 2017) and Kevin Seramur (Executive Vice President and CFO)
and Stefano Miele (Executive Vice President, General Counsel and Secretary).
SavaSeniorCare is a named party in ongoing litigation focused on violations of federal law. Cases of note include United States ex
rel. Hayward v. SavaSeniorCare, LLC, alleging that SAVA knowingly and routinely submitted false claims to Medicare for
rehabilitation therapy services that were not medically reasonable or necessary. In addition, SAVA and related entities were defendants in a previously settled lawsuit alleging that SAVA and other parties took illegal kickbacks to refer their residents to Omnicare for pharmacy services. The United States entered into a settlement agreement with SAVA, and other related parties. The settlement agreement required the defendants to pay a sum of $14.0 million to the United States. Somehow they keep operating…
Annaliese Impink, corporate counsel for the national for-profit chain said:
“While we will likely cooperate, we are weighing our options and will determine our next steps.”
Sava has 13 nursing homes across Georgia and 4 in South Carolina. At Roselane Health and Rehabilitation Center in Marietta, 99 residents have tested positive for COVID-19 and 14 died. At Sandy Springs Health and Rehabilitation, 66 have tested positive and 13 have died, according to the Georgia Department of Community Health. Sava nursing homes in other states have also had major outbreaks and large numbers of deaths, including almost all of its facilities in Maryland and Michigan, according to federal data. At one Pennsylvania facility, 173 residents were infected, and 48 died.
“We know that this is an unsettling and scary time for our residents and the community,” SavaSeniorCare Consulting LLC Chief Experience Officer Annaliese Impink wrote in a statement emailed to 7 On Your Side. “We understand and greatly appreciate family members’ concern for their loved ones and are doing everything in our power to keep our residents safe and protected.”
SavaSeniorCare Administrative Services LLC, the company that issued the statement, provides management services to nursing homes, and is based in Atlanta.
The Centers for Medicare & Medicaid Services announced plans today to end the emergency waiver and resume requirements for all nursing homes to submit staffing data through the Payroll-Based Journal (PBJ) system. Providers must have second-quarter staffing numbers to the Centers for Medicare & Medicaid Services by Aug. 14. Meanwhile, staffing data submitted for the end of 2019 will be captured for public posting and ratings.
CMS recommends that first-quarter data be submitted but does not require it. Industry apologist Steven Littlehale, chief innovation officer at Zimmet Healthcare Services Group advises not to submit the staffing data.
“While Q1 data will not be used in Five-Star, if you choose to submit it, it will be publicly accessible and be possibly used by others,” Littlehale cautioned. “I would be careful in sharing data externally that isn’t required, but keep meticulous documentation on your staffing and all your attempts to provide appropriate staff to your residents. Secondly, COVID-19 hit our nation hard, but not equally. Certain markets were severely hit, while others had no cases. Five-Star doesn’t adjust for these geographic variances.
Many families are asking themselves that question since COVID-19 policy has prevented families from visiting nursing homes. Many families have no idea what’s happening to their loved ones. They fear abuse and neglect.
One example is a family in NY who had photos showing Gloria Caldaroni-Ford’s mother Donata in her nursing home, with bruises under her eyes, a huge knot on her head and a big cut on her nose.
The incident happened before the COVID-19 pandemic. Caldaroni-Ford says her family only learned about the injury when they came to visit her mom the next day. The aide accused of causing her mother to fall was charged for not following procedure and for failing to report what happened.
“It is so important you don’t assume everything is okay behind closed doors,” Caldaroni-Ford said.
Advocates and experts agree that cameras should be allowed in rooms so families always have eyes on their loved ones.