The Times Union reported that Michael Levine, the owner of the Loudonville Home for Adults, is denying that he knew that Richard Ragone was a convicted rapist before he hired him as a maintenance man.  Ragone has been arrested for sexually abusing a 91-year-old woman at the home.

Richard Ragone was a Level 3 sex offender who spent more than 16 years in prison for rape and sodomy.  He was hired by the home in 2008 — the same year he came off parole–despite the fact that Levine admits that the home conducts criminal background checks.

In 1984, Ragone was convicted of first-degree rape, sodomy and attempted sexual abuse and sentenced to 12½ to 25 years in prison for victimizing a 43-year-old woman in Saratoga County.


Bloomberg News had an interesting article on a recent study by federal health care inspectors which said U.S. nursing home industry overbills Medicare at least $1.5 billion a year for treatments patients don’t need or never receive. That is incredible.  The national for profit chains were the worse offenders.  78 percent of $105 billion in revenues went to for-profits in 2010, up from 72 percent in 2002.  The emergence of national for profit chains is fueling waste, fraud and patient harm in the $2.8 trillion U.S health care sector.

Thirty per cent of claims sampled from for- profit homes were deemed improper, compared to just 12 percent from non-profits, according to data Bloomberg News obtained from the inspector general’s office of the U.S. Department of Health and Human Services.

“The November study that found $1.5 billion in improper nursing-home bills — equivalent to about 5 percent of total Medicare outlays to the facilities — was by the U.S. Department of Health and Human Services office of inspector general.  It followed a 2010 OIG report that found for-profit nursing homes were nearly twice as likely as nonprofits to bill Medicare at the highest rate for patients of similar ages and diagnoses.”

Nursing homes employ more than 1.6 million workers, second only to hospitals in the health care sector, according to the Alliance for Quality Nursing Home Care, the trade group representing for-profit facilities.   Most of these workers are certified nurse aides who get no health benefits and are paid minimun wage.  Understaffing leads to burn-out, stress, and lashing out at residents.

The 10 largest for-profit nursing-home chains employed 37 percent fewer registered nurses per patient-day between 2003 and 2008 — and received 59 percent more deficiency notices from government inspectors — than nonprofits did, according to a study published last year in the journal Health Services Research.”

“At a nursing home in South Carolina owned by Life Care Centers of America Inc., an 80-year-old woman who couldn’t control her head or keep her eyes open was placed in a standing frame for 84 minutes of physical and occupational therapy just two days before she died — one in a number of Life Care overcharges for unnecessary care, according to civil fraud allegations filed in November by the U.S. Justice Department in federal court in Chattanooga.”

In a civil complaint unsealed last month, U.S. prosecutors accused Life Care of billing Medicare for unnecessary and sometimes harmful treatments at its 230 nursing homes between 2006 and 2012.

This is what happens when for profit chains put profits over people.

Other blogs have discussed this report here and here.


Elizabeth Street, a wheelchair bound resident of Country Cottage Assisted Living in Georgia, suffered a horrific and preventable accident when her chair brakes were not set and her chair rolled down a hill and into a ditch of water. The woman, died of pneumonia a few days.   According to a report by the U.S. Centers for Disease Control and Prevention (CDC), approximately 1,800 elderly people residing in nursing homes die every year due to falls. Between 10 and 20 percent of nursing home falls result in serious injury; between 2 and 6 percent of injury falls result in a broken bone injury. Even when the fall does not cause death, it can result in permanent physical disability.  Falls are a major cause of depression, anxiety, social isolation, and reduced mobility. 

WBIR had an article on the off label use of anti-psychotics in nursing homes.  Health officials believe that too many patients with dementia are being given antipsychotics in an “off-label” use to control behavior instead of treating their dementia symptoms through non-pharmacologic therapy. Prescribing antipsychotics – approved by the FDA to treat schizophrenia and bipolar disorder among conditions – can expose a patient to medical risks.  The FDA requires that the packaging on those drugs contain a “black box warning” that administering them to elderly dementia patients increases the chance of death and can have other harmful side effects.

State health officials in Tennessee say the overuse of antipsychotic drugs nursing homes, particularly on those diagnosed with dementia, is a huge problem. About 30 percent of long-term nursing home residents in Tennessee are given antipsychotics, according to statistics collected by the Centers for Medicare and Medicaid Services. The national average is 23.8 percent, which federal officials want cut by 15 percent by year-end.

Dispensing pills is an effort to silence residents who are “acting out” without trying to find the underlying cause.  However, this increases the risk of fatal falls.


ABC7 in L.A. had a disturbing story about an elderly woman who was sexually attacked at a Emeritus Senior Living nursing home.  Now investigators say there could be more victims. David Moreno was an employee at Emeritus Senior Living who has been charged with sexually assaulting a 69-year-old disabled woman.  Police were able to get physical evidence from the scene that linked them to the suspect.


Robert Kuttner points out that there “are now more than 100 vacancies on the federal bench, out of some 856 federal district and appellate judges, far more than on the day Obama took office”.   During Obama’s first term, total judicial vacancies increased by 51 percent. During the first terms of Clinton and Bush, they declined by 65 and 34 percent respectively.

“Senate Republicans have resorted to unprecedented use of filibusters and threats of filibusters to keep the courts as Republican as possible for as long as possible. Even on district court judges, posts that used to be easily confirmed, Republicans have used filibusters 20 times. Obama’s total confirmation rate is 75 percent, compared to 88 percent for Bush four years into his presidency.

When Barack Obama took office in January 2009, the federal courts had been made over by the two-term Bush Administration. Bush had appointed fully 40 percent of all sitting judges.

“One of the archaic forms of Senatorial courtesy routinely abused by today’s Republicans is the long-standing custom of allowing the home state senators of a nominee to weigh in on a judicial appointment. The Judiciary Committee gives the two relevant senators a blue slip, which they are expected to return with favorable or unfavorable comments. Until the current era of vicious polarization, this courtesy more or less worked.”

“But in today’s poisoned atmosphere, the use of blue slips gives the Republicans three separate opportunities to obstruct. One or both home state senators can advise the White House that a proposed nominee will not get a blue slip. The Obama White House then typically comes up with a more moderate appointee. But after Republican senators have agreed to accept a nominee, they sometimes decide not to return the blue slip, as has been the case with about ten Obama nominees. And even after blue slips are returned, the Republican leadership sometimes decides to filibuster.”

“Today, with over 100 vacancies, according to a tabulation by the American Constitution Society, there are 30 judgeships for which the White House has yet to propose a nominee, including three in the northern district of Illinois—the president’s own hometown of Chicago. In terms of sheer numbers, Obama has lately appointed judges at a somewhat faster clip than in his first two years, but the trade-off is fewer liberals.”



The Associated Press reported the class action filed by federal judges for additional pay. The U.S. Court of Appeals for the Federal Circuit in October ordered Congress to pay six federal judges years of back pay. A group of federal judges is pushing a class-action lawsuit to ensure all of the rest of the federal judges who also missed out on their cost-of-living increases get their due.

Congress in 1989 limited federal judges’ ability to earn money outside of their work on the bench and in exchange provided what was supposed to be automatic cost-of-living increases to judicial salaries to ensure inflation wouldn’t erode the value of those salaries over time.  Congress withheld those cost-of-living increases in 1995, 1996, 1997, 1999, 2007 and 2010, while giving other federal employees their promised increases.  The Constitution says compensation for federal judges “shall not be diminished during their continuance in office,” so the judges say denying them a promised cost-of-living increase violates the Constitution’s Compensation Clause.


NBC News had an interesting article,in the cost and quality of U.S healthcare.  Most Americans assume it is the best in the world based on patriotism and not facts.  “Health insurance premiums have shot up more than 60 percent in the last eight years, and if they keep up at this pace the average family of four will be paying $25,000 a year just for health insurance, according to a report from the non-profit Commonwealth Fund.  Deductibles are also going up for employer-sponsored plans, so workers are paying more and more for less and less.

“Broad evidence of poorly coordinated care, duplicative services, and administrative waste, as well as rising prices charged to those privately insured, signal that greater efforts are needed to slow cost growth in both private and public insurance markets,” the report finds.  The U.S. health care system wasted $750 billion in 2009, about 30 percent of all health spending, on unnecessary services, excessive administrative costs, and waste.

Read More →

The Times News reported the closing of Sava owned and operated Brian Center of Weber City with an extensive history of compliance problems after the federal government finally took action to terminate its ability to accept Medicaid and Medicare reimbursements.  The facility is now known as Continium Care of Weber City.

“According to a nursing home license application filed with the Virginia Department of Health Office of Licensure and Certification in October 2010, the facility is managed by Continium Health Care Management LLC located at 10800 Biscayne Blvd., Suite 810, Miami, Fla. The LLC’s president/chairman is listed as Avi Klein of Miami.”  Klein’s partners include Abraham Shaulson, Murray Forman, and Leonard Grunstein.  I’m sure they bled the facility dry before closing the facility down.  In October 2010, the facility, which was then known as the Brian Center, was investigated by the Internal Revenue Service for possible violations of wire fraud, mail fraud, health care fraud and money laundering.

Read More →

Politico reported on the Independent Payment Advisory Board which includes a legally binding brake on Medicare spending.  The panel is supposed to have 15 experts who will recommend changes to provider payments if Medicare spending grows above specified targets.  The panel is supposed to recommend spending cuts to health care providers if per capita Medicare spending exceeds targets set in the 2010 law. The formula is complicated and has two stages: In the first few years, the triggers are tied to inflation rates, but by 2020, the goal is to hold down the growth of Medicare spending to the gross domestic product plus 1 percent.

“IPAB was incorporated in the Senate version of the health bill and strongly supported by the White House. It never had as much support in the House, where more questions were raised about giving an outside group the power to make spending decisions that had always belonged to Congress.”
“The rationale, supporters said, was twofold. First, Congress didn’t always have the expertise to grapple with some of the most technical aspects of health care pricing. And second, all the health care industries and lobbies make it hard for Congress to make cuts or make the most sensible ones.”