A federal task force charged 90 people, including 16 doctors, with generating $260 million of false Medicare billings following raids in cities across the country. The arrests mark the seventh notable crackdown by the Medicare Fraud Strike Force, a joint effort of the Justice Department and the Department of Health and Human Services launched in 2007,  See article at The Wall Street Journal.

Tracy Deckman, who works for Senior Dental Services, contacted us to inform us that Senior Dental Services brings dental care to nursing homes at no additional cost to the resident or facility. Their website is www.elderlydental.com.  According to the U.S. Surgeon General, 70% of long-term care residents are not provided with acceptable dental care.

Unlike years ago, 50-75% of all nursing home residents today keep their own teeth into their senior years. A study conducted by the American Academy of Periodontology concluded, “people with gum disease are at double the risk of developing cardiac disease and stroke in comparison to those with healthy gums.

Furthermore, long-term care facilities lack the time, staff, or other resources needed to provide oral hygiene.  However, Senior Dental Services is dedicated to providing a solution to the lack of oral hygiene care and improving the quality of life for LTC residents.

 

The Republic reported that Florida lawmakers, after granting immunity to nursing home owners who systematically neglect and abuse residents, ended the session by killing an omnibus health bill that would have expanded the powers of nurse practitioners and promoted the use of telemedicine.  Proponents said both measures would reduce health care costs and address a critical shortage of primary care physicians in the state.

Several hospitals around the state have had success with telemedicine in recent years, helping patients in rural areas connect to specialists or getting multiple consultations conducted simultaneously for acute emergency cases.  But the powerful Florida Medical Association opposed the telemedicine provision and warned that nurse practitioners should not have powers to prescribe controlled substances without a doctor’s supervision in a state that has been a hotbed for pill mills.

 

The Washington Post recently reported on the premium payment rates for private insurers based on testimony before Congress.  House Republicans summoned a half-dozen health insurance executives to a hearing but insurers refused to go along with the plan to criticize ObamaCare, and surprised Republican critics of the law by undercutting some of their arguments against it. Insurers, appearing before a panel of the Energy and Commerce Committee, testified that the law had not led to a government takeover of their industry, as some Republicans had predicted. Indeed, several insurers said their stock prices had increased in the last few years.

Top health insurance companies also told members of Congress that more than 80 percent of people who’ve signed up under the president’s new health care law have gone on to pay their premiums — a necessary step for the enrollment figures touted by the Obama administration to hold up.

Aetna reported payment rates in “the low- to mid-80 percent range;” Wellpoint said the rate was as high as 90 percent for those whose premium had come due; the Blue Cross and Blue Shield Association said 80 to 85 percent; and the Health Care Service Corporation, which sells Blue Cross Blue Shield plans in five states, pegged the rate at 83 percent or above. The figures were in line with what individual insurers have said on earnings calls with analysts and elsewhere in recent weeks. These figures are the latest sign that the health care law has defied its critics and is working.

 

 Aviv REIT, Inc. announced it has acquired eight post-acute and long-term care skilled nursing facilities ("SNFs") in California and Texas, in three separate transactions for $70.7 million. These acquisitions are follow-on investments with existing operator relationships and the opportunities were brought exclusively to Aviv by the operators. These triple-net leases have a blended initial cash yield of 9.7%, annual escalators and lease terms of ten years.

Four of the SNFs, located in Texas, were purchased for $53.7 million and are triple-net leased to existing Aviv operator Fundamental Long Term Care ("Fundamental"), an operator of 76 SNFs in 9 states, at an initial cash yield of 9.5%. Three of the SNFs, located in California, were purchased for $13.4 million and are triple-net leased to existing Aviv operator Providence Group ("Providence"), an operator of 12 SNFs in Kentucky and California, at an initial cash yield of 10.25%. The remaining SNF, located in Texas, was purchased for $3.6 million and is triple-net leased to existing Aviv operator Trinity Healthcare, LLC ("Trinity"), an operator of five SNFs in Texas, at an initial cash yield of 10.75%.

"We have already completed $181 million of accretive acquisitions in 2014 and these acquisitions have further enhanced our operator and geographic diversification, consistent with our overall strategy," said Craig M. Bernfield, Chairman and Chief Executive Officer of Aviv. "Fundamental, Providence and Trinity have successful track records with us and we expect to continue to build our relationships with them. We have a strong pipeline of identified acquisitions and we are confident about our growth prospects for the balance of 2014."

About Aviv Aviv REIT, Inc., based in Chicago, is a real estate investment trust that specializes in owning post-acute and long-term care skilled nursing facilities and other healthcare properties. Aviv is one of the largest owners of SNFs in the United States and has been in the business for over 30 years. The Company currently owns 303 properties that are triple-net leased to 39 operators in 29 states.

Raheel Pervez , a pharmacy owner, has been sentenced for his part in a scheme that drained $16 million from the NY Medicaid program.  Pervez will only serve one to three years for his part in a scheme that billed Medicaid for unfilled prescriptions. The pharmacies were ordered to pay $16.7 million in restitution to Medicaid and Pervez has agreed to pay $500,000 in civil forfeiture.

His father Mujahid "Peter" Pervez controlled the three indicted pharmacies but fled to Pakistan.  Pervez’s father had previously been excluded from participating in the Medicaid program because of a fraud conviction.  Five other people were arrested in connection with the crime.

Kaiser Health News had an article about the new requirement in ObamaCare that requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.  Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists of 30 questions (such as “What month is this?” and “What country are we in?”) and may be completed in about 10 minutes.  Seniors may want to consider having an evaluation for cognitive impairment as part of their annual wellness visit with their health provider. It is covered with no out-of-pocket charge.

“The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it.”

Alzheimer’s is the most common form of dementia, accounting for up to 80 percent of cases. Other types include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease. The drugs that are available are most effective in the early stages of the disease.

The case involving Fundamental Long Term Care Holdings, Inc. involving $1 billion in wrongful death and other judgments can proceed, a federal court has ruled. The matter also involves private equity firm GTCR, which was helmed by current Illinois Republican gubernatorial candidate Bruce Rauner.

In 1998, the GTCR Group provided initial funding for Trans Healthcare Inc., a company operating Florida nursing homes and other post-acute and long-term care facilities. By 2006, Trans Healthcare was facing 150 lawsuits, with allegations including financial mismanagement, resident neglect and wrongful death. The judgments against the company at one point came to more than $2.3 billion.  To get out of the paying for their negligence, THI Holdings sold the facilities to Fundamental Long Term Care Holdings, L.L.C. but then sold related entites to undercapitlized Fundamental Long Term Care Holdings, Inc. so they would left holding the bag when the judgments came due.

The plaintiffs allege that GTCR and Fundamental Long Term Care Holdings, L.L.C. engaged in a “bust-out” scheme, or a transfer of assets to avoid paying out to creditors and parties awarded damages, prior to Trans Healthcare going out of business and entering state-court receivership.

The judge’s statement that “GTCR Group was also instrumental in [Trans Healthcare’s] day-to-day management and administration”.

 

Improper Medicare payments cost about $50 billion last year, a Health and Human Services official told a House panel, testimony that prompted a rare display of bipartisanship in a usually divided House.  In 2013, the government recovered $4.3 billion from people trying to defraud the government, and has recovered $19.2 billion over the past five years — about $10 billion more than the previous five years.  See full article at USA Today.  The traditional Medicare fee-for-service program lost $36 billion, while Medicare Advantage lost $11.8 billion. Improper payments in the fee-for-service program made up 10% of all payments in 2013, up for 8.5% in 2012, she said.

“Every dollar lost to Medicare fraud is a dollar stolen from America’s elderly,” said Rep. Kevin Brady, R-Texas, chairman of the House Ways and Means Subcommittee on Health. “And every dollar lost to improper payments — intentional or not — robs from the solvency of this important program.”

CMS has pilot programs to prevent fraud and has started screening all 1.5 million Medicare suppliers under new requirements. So far, 260,000 providers and suppliers have had their billing privileges deactivated for not responding. Another 17,534 had their billing privileges revoked because they had felony convictions, had incorrect addresses, or did not have proper licensing.

President Obama’s latest budget request seeks $428 million for Medicare fraud-prevention programs, which could yield $13.5 billion in savings for Medicare and Medicaid over 10 years.  The budget also asks for 17 legislative changes that would provide more tools to fight fraud and help repair vulnerabilities, including expanding a pilot program that makes sure improper payments aren’t made by giving CMS the authority to require prior authorization for fee-for-service items. The Power Mobility Devices Prior Authorization Demonstration has decreased spending by $117 million.

 

 

McKnights wrote on the findings of a study in Health Affairs which indicates that nursing homes are sending residents with dementia to the hospital more often than is needed during their last year of life. Two-thirds of the patients reviewed in the study had at least one potentially avoidable hospital stay during their final year.  The study examined data from 2000 to 2008 and tracked over 12,000 individuals to find these patterns. The information highlights the need to have advanced care planning in place for individuals with dementia long before death.