McKnight’s reported that Rafael Chikvashvili, owner of Baltimore-based Alpha Diagnostics LLC, was convicted of two counts of healthcare fraud resulting in death, wire fraud, false statements and aggravated identity theft. He faces a maximum sentence of life in prison for each of the counts of healthcare fraud resulting in death. Separately, he faces up to 20 years on the other charges.

Chikvashvili created false radiology and ultrasound reports for patients, and submitted reimbursement claims for services that were never provided, or that Alpha was not licensed to provide. He also instructed non-physician employees to interpret X-rays, ultrasounds and cardiologic examinations and draft false physician reports. Chikvashvili would then forge a physician’s signature on the reports and submit them to Medicare.

Two patients died as a result of having their X-rays interpreted by unqualified Alpha employees, authorities say.

Alpha employees misinterpreted the chest X-ray of one nursing home resident with congestive heart failure, who remained at the facility instead of being transferred to a hospital for treatment. She died four days later. If she had been moved to a hospital, her life expectancy would have increased, witnesses said.

A second patient’s chest X-ray showed mild congestive heart failure, which raises the risk of bleeding during surgery. An Alpha employee failed to detect the heart failure on the patient’s X-ray, and the patient was cleared to undergo elective surgery. She experienced significant bleeding during and after the surgery, and died six days later.

Alpha Diagnostics submitted claims to Medicare for both patients, saying their X-rays had been interpreted by licensed radiologists. The company, which provided services in Maryland, Delaware, Pennsylvania, Virginia and the District of Columbia, defrauded Medicare and Medicaid out of $7.5 million between 1997 and 2013, authorities said.

“The evidence showed that Rafael Chikvashvili failed to provide medical services to patients who needed them, and billed for services that he did not provide,” U.S. Attorney Rod J. Rosenstein said in a news release.

ABC27 continues to investigate nursing homes after first reporting new, disturbing violations in Golden Living facilities.

Reports from the Department of Health over the last two years show violations in York and Cumberland county-owned nursing homes.  York County’s Pleasant Acres Nursing and Rehabilitation Center had the most violations. The report says a resident fell out of his wheelchair and suffered a head injury. He started to have headaches, his pupils were not reacting to light, and his speech was garbled and slurred.

The chart documents that a doctor was allegedly notified two days after the fall, but the Department of Health discovered no evidence of a doctor’s evaluation until nine days after the fall. That’s when the resident went to the hospital. Medical reports show he had a painful fracture.

In other reports, inspectors found “dried bowel movement” on a shower floor, a lack of evidence that some residents were bathed properly, a “medication error rate of 11.1 percent,” and in some cases, the facility flat-out not running tests that doctors ordered.  Inspectors also wrote about sanitary concerns in the kitchen in 2015  after they discovered some food in the pantry expired in 2011.  Reports showed the facility “failed to maintain effective infection control techniques.”

Additionally, there was an incident in 2014 when a patient sat outside for several hours and later went to the hospital for “neurogenic shock and severe hypothermia.”

 

 

A man who legally changed his name to ‘The Reverend’ has been charged with the brutal murder of Gary Glueck, a 71-year-old nursing home resident, police said.  Both men were residents of the Scottsville Manor nursing home.  The 35-year-old suspect, formerly known as Robert Reynolds, also lived at the nursing home but now was being held in the Allen County Detention Center, the Scottsville Police Department said in a news release.

 

Police say the men had been arguing.  Glueck died from strangulation after being stabbed with a pen and having an electrical cord wrapped around his neck.  “The gentleman who had changed his name, his legal name, to The Reverend, came to the nurse’s station to get a drink of water and said he had killed Gary.”  Clearly The Reverend was mentally unstable and dangerous and needed to be supervised.  How many other incidents had he been involved in?  what did the managment know about The Reverend?

The incident marks the 4th murder in Allen County in less than four months.

 

 

The Times Free Press reported that Trent Tolbert paid himself $36,000 a month at New Beginnings Care LLC, the Hixson-based nursing home business he co-founded in 2011, and drove a company-financed Porsche, while failing to pay employees, utility bills, taxes and creditors, according to court documents. Tolbert and New Beginnings’ co-founder, Debbie Jones — who made $24,000 a month and also drove a company-leased Porsche — filed for Chapter 11 bankruptcy Jan. 22. The duo previously held executive positions at two Chattanooga-area nursing home businesses: Grace Healthcare and Life Care Centers of America.

John M. Reed was the first of eight nursing homes operated by New Beginnings that have closed or will close by the end of March.  A home in Youngstown, Ohio, closed Jan. 29 after state inspectors found it was understaffed because workers quit over not being paid. At least seven of the 44 residents wore two layers of adult diapers “saturated” with urine or feces, the inspection found, and residents weren’t being repositioned in bed to prevent skin breakdown, including one who had ulcers on both heels.

 

New Beginnings owes close to $7 million to unsecured creditors, or those without collateral, according to court filings, with the highest amount being $1 million owed to the Bureau of TennCare.  New Beginnings operates, but doesn’t own, nursing homes in low-income rural areas.  It had $63 million in revenue in 2015, court filings say. But it listed its assets as less than $50,000.

 

The Orange County Register had an interesting article regarding the excessive cost and doubtful medical necessity of expensive therapy in nursing homes.  “Nursing homes in California – and notably in Orange County – are outpacing the nation in embracing the most expensive form of therapy for their patients on Medicare, triggering an outcry from some therapists who say the treatment frequently is unnecessary.”  The practice, known as ultra-high care, can require frail patients to receive at least 12 hours of physical, occupational or speech therapy every week.  Ultra-high care is one of five Medicare therapy categories. The four others range from low to very high.  The difference between ultra-high and very high therapy: 720 minutes a week (12 hours) vs. 500 minutes a week (8 hours and 20 minutes). Therapists are ethically bound to “deliver services that they believe are medically necessary and in the patient’s/client’s best interest,”.

Therapists say they’re being told by nursing home supervisors to give inappropriate treatment to patients, according to the three major therapist professional groups including  American Physical Therapy Association.   Consumer advocates and government watchdog agencies, such as the inspector general at the U.S. Department of Health and Human Services, have long warned Medicare of potential abuses and have urged reforms.  The California Health Care Foundation Center for Health Reporting found 72 percent of Medicare rehabilitation patients in Orange County nursing homes in 2014 received treatment at the highest rate. That compares with 58 percent nationwide, 

They would pretty much twist the therapists’ arms and say, we need another week at the ultra-high level,” she said. And when she handled patient discharges, she said, “if they still had Medicare benefits available, they would not let me discharge them.”

Federal prosecutors allege in pending lawsuits against two nursing home chains that therapists were ordered to treat dying patients. And the nation’s largest chain agreed Jan. 12 to pay $125 million to settle federal charges that it submitted false therapy claims.

Boosted by therapy billings, Medicare has delivered at least a 10 percent profit margin to the nursing home industry every year for 13 years, according to figures from the congressionally chartered Medicare Payment Advisory Commission, known as MedPAC.  The profit – not the revenue – for a single day of ultra-high therapy for one patient is $66 compared with $45 for the next most intensive form, “very high,” according to estimates in a September 2015 report by the Health and Human Services inspector general.

A handful of nursing home therapists have turned whistleblower, filing lawsuits under the federal False Claims Act.

In November 2013, Ensign Group agreed to pay $48 million to settle a case involving allegedly false rehab claims at Sea Cliff Healthcare Center in Huntington Beach and five nursing homes in other Southern California cities. Two therapists had filed the suit.

Pending cases against two of the nation’s largest nursing home chains, HCR ManorCare and Life Care Centers of America, allege managers pressured therapists to step up treatments. The chains also are accused of administering expensive therapy to dying patients.

 

KSTP reported the horrific abuse caught on hidden camera at the Glenn Hopkins senior home.  Police say a hidden camera set up by the family captured an aide repeatedly beating the woman.  The resident’s daughter set up a camera at the Glenn Hopkins senior home after finding unexplained bruising on her mother.

The family shared the video with Hopkins police who arrested a 55-year-old aide, identified as Cecilia Chebii Soi, has been charged with two counts of assault.  Police say the aide could be seen on the video using her hand, elbow and a hair brush to hit the woman in the head. The video also showed the elderly woman was pulled up from the floor by her hair.

If convicted, Soi faces up to one year in prison and $3,000 in fines on the fourth-degree assault charge and up to 90 days in prison and $1,000 in fines on the fifth-degree assault charge.

The Consumerist had the below article on the dangers of singing away your loved one’s constitutional right to a jury trial by signing the admission paperwork.

When an elderly parent is no longer able to make sensible medical decisions for themselves, an adult child is often named a medical proxy to handle these important calls. But does this life-or-death authority over a parent’s medical care carry over to things like signing legally binding contracts, and possible signing away your, or your parent’s, right so sue their nursing home?

The NY Times DealBook has an in-depth look at a years-old legal battle between a Massachusetts nursing home and a man whose mother was killed by her roommate at that home back in 2009.

The son is trying to sue the home, alleging that it disregarded signs that his mother’s roommate posed a threat to others. However, his initial attempts at bringing the lawsuit failed because he had unwittingly signed away his right to file a legal complaint.

When his mother had moved into the home, the son — her medical proxy — signed the contract on her behalf. That contract included a binding arbitration clause, which bars all the parties in a contract from going to court to resolve legal disputes, even wrongful deaths.

Instead of a courtroom, such complaints must be handled through an outside arbitration process that has repeatedly been shown to be out-of-balance in favor of the companies that draft the contracts,given their familiarity with the process and with the arbitrators.

For example, the Times notes that the arbitration firm hired to hear this dispute has handled more than 400 arbitrations for the law firm representing the nursing home company.

However, courts have long been reluctant to overrule these clauses, even when it’s been shown that the person signing the contract could have had no idea what they were agreeing to.

So it’s not surprising that when this matter went to arbitration, the ruling came down in favor of the nursing home. And because this was a private arbitration matter, no explanation was given by the arbitrator. He merely checked off a box indicating his decision.

But last year, lawyers for the son were successfully able to convince a state court that the son was not legally able to sign away his mother’s right to sue, because he was only her medical proxy. Their contention is that he would have needed power of attorney in order to sign a legally binding contract on his mother’s behalf.

The son’s case is slated to go before the court next month. It could stand as precedent for others trying to challenge an arbitration clause in a nursing home contract.

This sad story also illustrates why it’s so important for you to review contracts for arbitration clausesbefore you sign them. Once a contract is signed, it’s very difficult to undo, especially now that the U.S. Supreme Court has repeatedly upheld the use of forced arbitration.

Earlier this month, Sen. Patrick Leahy of Vermont and Sen. Al Franken of Minnesota introduced the Restoring Statutory Rights Act, which would create an exception in the 1925 Federal Arbitration Act for disputes involving individuals and small businesses.

Under that proposed law, which sadly stands little chance of passing, the only way individuals would enter into arbitration is if they agreed to do so after a legal dispute has been filed. That’s very different from the current process, which automatically shunts all customer disputes into binding arbitration.

WQAD reported the callous antics of Claude Shinall.  Shinall is a nursing home worker accused of killing an elderly dementia patient.  Shinall is charged with first-degree murder in the death of 79-year-old Gene Farnsworth, formerly of Davenport.  Shinall is accused of choking and beating the man in his room in October at Marigold Nursing Home in Galesburg.   He was seen waving and giving spectators the middle finger including where Farnsworth’s family was sitting when entering his court hearing.   Farnsworth died one month later, but was able to speak with police in the emergency room at the time of the incident.  Farnsworth told police that a dark haired man had tried to kill him in his room, choking him, and punching him.

Officer Mark McLaughlin testified he later interviewed Shinall, who told him he choked the elderly man because he was angry that he kept falling out of bed.  McLaughlin also testified that a forensic pathologist concluded that Farnsworth’s death was a result of complications due to the choking.

“My brother was 79 years old and he was helpless,” said Linda Harvey, the victim’s sister.  “There’s no way he (Shinall) should have been in a nursing home with his anger issues,” she said.

 

Several central Ohio advocates are calling for increased training and penalties after a national investigation uncovered numerous incidents of health-care workers posting humiliating and dehumanizing photos of elderly patients on social-media sites.

“It’s the most vile, disgusting thing I’ve ever heard of,” said Antonia Carroll, director of the Franklin County Office on Aging. “I find it incredible that someone charged with caring for a vulnerable older adult would be so disrespectful and repulsive.”

The story section of Snapchat also allows users to share videos with their friends for 24 hours, as opposed to only selected contacts for up to 10 seconds, which is what happened in the case involving the Autumn Care Center in Newark on Feb. 21, 2015.  In that incident, a nursing assistant recorded a video of two residents lying in bed in hospital gowns being coached to say “I’m in love with the Coco,” the lyrics of a gangster rap song, according to state health-inspection reports. “Coco” is slang for cocaine.

When the male resident said the line, a banner appeared across his chest with the words “ Hahahhahaha omg” with three laughing emojis. As the female resident repeated the phrase, a banner across her chest said, “Got these hoes trained.”

Both patients had physical and cognitive disabilities and required extensive assistance from workers at the nursing home. The woman’s son told inspectors that his mother had been a church secretary for 30 years and would have been embarrassed by the video.

Facilities and their employees sometimes violate your trust in horrific ways. That recently includes a disturbing incident involving a 21-year-old woman who worked at a nursing home in Wisconsin.  She took inappropriate videos of a 93-year-old woman with Alzheimer’s disease. Worse, this employee, Grace Riedlinger, shared those videos on the social media site Snapchat, which has videos viewed more than 7 billion times every day.

A good Samaritan who saw the disturbing video reported it to the nursing home.  Riedlinger was recently charged with a felony. She’s facing possible jail time of 18 months, plus two years of supervised release.

This creepy and disturbing incident is more common than you may think. Since 2012, three dozen incidents of inappropriate nursing home videos have been found online, including on Facebook, Instagram and Snapchat, according to the investigative journalism site ProPublica.  ProPublica identified 35 instances since 2012 in which workers at nursing homes or assisted-living centers surreptitiously shared photos or videos of residents, some of whom were partially or completely naked. The independent, nonprofit online news source searched government inspection reports, court cases and media reports.

See articles at Kommando and The Columbus Dispatch.

ABC27 had an interesting article about the sufficiency and reliability of information provided during nursing home inspections.  Following a special report about Pennsylvania’s nursing home system and potential solutions to ongoing problems, ABC27 is investigating the inspection process.

Families who have seen loved ones live in filthy conditions say it’s an important issue. “I picked up feces off the shower floors,” Sandra McManamon said while telling ABC27 about her mother’s nursing home stay. “I cleaned it off walls, I cleaned it off shower curtains, commodes clogged with it for a week. For a week.”

Sandra’s mother lived in Golden Living’s Blue Ridge Mountain facility for four years; it’s where she died.  Department of Health inspections show several violations in Golden Living facilities. However, many surveys conducted in response to complaints found “no deficiencies.”

ABC27 wanted to know how that could happen, given the conditions several residents, family members, and even a lawsuit from the attorney general described.

Secretary of Health Dr. Karen Murphy says there are two types of inspections: the required annual survey and surveys in response to complaints. Both kinds of inspections are supposed to be unannounced. However, there are claims some nursing homes found a way around that.

The attorney general’s lawsuit against Golden Living facilities says they “deceived the commonwealth … by increasing staffing during inspections,” even “using office and administrative staff to provide direct care to residents.”

“They would be checking rooms, ‘Oh…how are you? Is everything alright?’” Sandra said. “They’d have office staff come in. As soon as the Department of Health was gone, most of them were sent home.”

 

“I don’t want to hold grudges,” she said. “I don’t want to do anything but turn this into a positive, for these people to realize that these older people need help, they need medical care, and they have rights to get that.”