A few weeks ago, we posted a blog about the connection between doctors and prescription sales. In that article, financial data was used to show that doctors who worked with a pharmaceutical company, giving presentations and speeches, were more likely to prescribe a drug that the company had marketed.

In a similar tale of big pharma influence, one St. Louis company has been entangled in a lawsuit under the False Claims Act. John Prieve, the whistleblower who brought forth the suit, worked at Mallinckrodt LLC. In his suit, he claims that Mallinckrodt defrauded the government because they used financial incentives to increase the number of doctor prescriptions their drug got. In doing so, many of the prescriptions were paid by Medicare and Medicaid, essentially placing the added cost on the government. The suit alleges that the company ‘targeted doctors’ who prescribed similar drugs in an attempt to increase sales of the less effective and more expensive antidepressants and sleep aids that Mallinckrodt made. The company is settling the suit for $3.5 million.

Documentation has been a growing problem in the healthcare industry especially short-staffed nursing homes.  In an article from Medscape, issues with charting are looked at and explored for potential problems. A nurse posed a question about charting. She detailed how the electronic charting system at her hospital was so cumbersome that many nurses had to stay over their shifts, which necessitates overtime, or they were clocking out and entering notes on their own time so that the charts would be up to date. The problem, she said, is that by the time the notes are entered, the patient’s condition could have drastically changed. Since the system records the time of the notes, this could lead to issues of charting integrity and in some cases, HIPAA violations.

The documentation standard is for charts to be updated within an hour of the assessment or treatment, unless more frequent updates are required, such as for a patient who requires more frequent nurse assessments. Untimely documentation leads to issues of the credibility of those notes. If a patient dies at 8:00 and the nurse enters her notes that he is healthy and well at 8:15, there’s obviously an issue of integrity.

Electronic charting systems, like all newly implemented computer systems, will require some work to become familiar with the program. Maybe the nurses are going through a learning period, and as they work with the program it will be easier to use and easier to timely enter chart notes. If the system is too difficult to work with, nurses are probably not the only ones having problems. If doctors and nurses are both frustrated with the system, then a meeting should be set up with the administration. In either case the situation is going to require time. For right now, it seems inevitable that charting integrity will continue to be a source of concern for many hospitals.

McKnight’s reported thatTennessee-based nursing home operator Grace Healthcare LLC will pay the federal government more than $2.7 million, settling charges that Grace violated the False Claims Act by billing Medicare for unnecessary rehabilitation therapy.   A whistleblower said 10 Grace-operated skilled nursing facilities billed for unnecessary and unreasonable physical, occupational and speech therapy to meet the corporation’s reimbursement goals from 2007 to 2011.

The government proved that Grace’s billing was an example of “waste and abuse” driven by “financial considerations,” said U.S. Attorney for the Eastern District of Tennessee Bill Killian.  Grace will enter into a Corporate Integrity Agreement regarding its therapy services as part of the settlement. The former Grace employee received $405,000 under the settlement agreement.

 

The Washington Post reported that the Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care industries.  The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.

 

Recently, the Obama Administration charged 107 people across the country for allegedly running a string of unrelated Medicare fraud schemes involving a total of $452 million in false claims.  The amount of bogus Medicare claims, totaling about $452 million, was the highest in a single raid in the history of a federal strike force combating rising fraud in the medical industry.  Defendants include doctors, nurses, and social workers in seven cities.  The arrests are for seeking to defraud the federal health program for the elderly and disabled.  As a result of the latest arrests, the department had blocked payments to 52 health-care providers suspected of being linked to the fraud rings.

One scheme included recruiting elderly, mentally ill and drug-addicted patients from nursing homes and homeless shelters. The suspects allegedly signed up the recruits for mental-health services billed at $225 million over six years that never were given or were medically inappropriate, according to officials.

The departments of Justice and Health and Human Services have stepped up their efforts to combat Medicare fraud in recent years, and say they are trying to shift their focus to stopping the government from paying false claims rather than trying to recover the money later.

See articles at Wall Street Journal, N.Y. Times, and L.A. Times.

Kaiser Health News published an interesting survey that showed doctors are not always honest with patients, especially when it comes to disclosing a medical mistake, or discussing a difficult prognosis.  "Despite wide acceptance of a professional code that endorses openness and honesty with patients, a 2009 survey of 1,891 doctors published in the February edition of Health Affairs found gaps between those standards and how they actually practice."

The vast majority of physicians say they embraced the American Board of Internal Medicine Foundation’s Charter on Medical Professionalism which demands fully informing patients about the risks and benefits of all available interventions.  More than a third said they did not completely agree it was necessary to disclose “all serious medical errors to affected patients.”  "Even more striking, one in five acknowledged they had not fully disclosed an error to a patient in the previous year because they feared a lawsuit."

"More than 55 percent of physicians reported they often or sometimes described a patient’s prognosis in a more positive manner than the facts might support.  Meanwhile, 11 percent of respondents said they had told patients something untrue in the previous year, and 17 percent did not completely agree that physicians should never tell a patient something untrue." 

The authors point out that their estimates may be low because of the tendency to respond to questions in a way others regard favorably.  The survey also found notable variations correlated with race, gender and physician specialty. For instance, women and minorities were significantly more likely to follow standards for honest communication compared to white male doctors, which the authors suggest may be due to greater vigilance about the code on the part of newcomers to the profession.

The Center for Survey Research at the University of Massachusetts, Boston, administered the eight-page survey in May 2009 to 3,500 physicians drawn from seven specialties. Almost two-thirds, or 1,891 completed the survey.

 

The Galveston Daily News reported the wrongful death lawsuit filed on behalf of Rachel Mohr after Regent Care Center failed to prevent her fall, appropriately assess her after the fall, and transfer her to the hospital for emergency care.  Mohr was a high fall risk, but a care plan and nursing interventions to prevent a fall weren’t followed: low bed position and floor mats and a bed alarm weren’t used contrary to a physician’s orders.

On March 4, Mohr was heard yelling for help and found on the floor next to her bed. Mohr suffered head trauma and was bleeding after the fall.  Instead of doing an assessment or transferring her to the hospital, nursing home employees placed her back in bed.  Mohr was later discovered unconscious and nonresponsive.  Mohr was finally taken to the hospital where she died from her injuries.

The lawsuit also claims Regent Care Center’s nurses were not adequately trained or apprised of Mohr’s care plan.

Relatives requested on 10 occasions and provided authorization for copies of Mohr’s medical chart, but Regent Care Center refused to provide the chart.  “Defendants refused to produce the chart on the basis that its lawyer had the chart and further refused to provide the lawyer’s identity and contact information,” the lawsuit claims.  Residents and their family members have a right to be provided a copy of the chart within 48 hours of a written request.  But nursing homes often send the chart to lawyers to "fix" any blanks or other documentation failures.

Relatives attempted to settle out of court with the center for $275,000, according to a letter which is on file with the lawsuit.
 

Texas-Legal Eagle reported the arrest of Rose Munoz Rodriguez, a nursing home owner/operator accused of lying under oath during a civil suit involving the nursing home business she used to run.  Rodriguez operated The Rose Home — a series of small nursing homes throughout Bryan and College Station — and was accused in a January civil suit of improperly caring for a client, Danese Medders Maxwell.  Maxwell developed severe bed sores because of the insufficient care she was receiving while staying at The Rose Home. The lack of proper treatment, the family asserted, resulted in Maxwell dying sooner than she would have if she’d received adequate care.

Rodriguez faces three counts of aggravated perjury, a third-degree felony punishable by up to 10 years in prison. In addition, charges against the former caretaker for the elderly include tampering with evidence, also a third-degree felony, theft of property between $1,500 and $20,000 — a state-jail felony punishable by two years behind bars — and four misdemeanor charges.

According to the perjury and tampering with evidence indictments, Rodriguez lied three times under oath about incorrect information in Maxwell’s records when she knew that the charts were false.

Corporate owners of nursing homes often pressure their administrators and employees to cover up neglect and lie under oath.   Arrests for perjury are far too rare. 

 

The Sacramento Bee wrote an incredible series of articles about the edpidemic of false and fraudulent charting in nursing homes.  The practice of nursing homes altering patients’ medical records masks serious conditions and covers up care not given. A Bee review of nearly 150 cases of alleged chart falsification in California reveals how the practice puts patients at risk and sometimes leads to death.  We see it in every case.  Care documented that was clearly not given even notes when the residents was not in the facility.  Excerpts of the recent editorial are below:

Nursing homes make record- keeping mistakes. Sometimes the mistakes are innocent. Sometimes, as The Bee’s Marjie Lundstrom has demonstrated in her investigative report on bogus nursing home record-keeping, they are deliberate – a pattern of deception intended to lull family members into believing that their loved ones are receiving appropriate care and to protect corporate nursing homes from lawsuits when a patient is seriously injured or killed.

That overworked and understaffed nursing home personnel might fail to document all of their actions is understandable but also dangerous. Of course, when they falsify their actions, it’s criminal.

The cases described in The Bee series show that sloppy and false record-keeping can be deadly. In some of the cases reviewed, those who signed medical reports did not exist or were not working the days they claimed to have performed the services. In other cases, nursing home workers say they were ordered to alter records. Detection and prevention is not always easy.

 

According to the Cincinnati Enquirer, the U.S. Attorney’s Office filed a civil complaint accusing Villaspring Health Care and Rehabilitation in Kentucky of providing services that were “inadequate” and “essentially worthless.” Villaspring’s parent company is Carespring Health Care Management.  The suit says that the nursing home violated the federal False Claims Act, committing common law fraud and unjust enrichment.  The neglect directly led to the death of five residents.  According to U.S. attorneys, several patients died from 2004-2008 due to the inadequate care.

Hours after news of the lawsuit became public, a woman who says she saw the lack of care first hand, spoke with Local 12’s Tiffany Wilson. She says her uncle was a resident at Villasprings. On one occasion, she says he went three weeks without a bath or a change of clothes. Another time, she found him slumped over in a hallway, and according to her, he was slipping into a diabetic coma.

Defendants face financial penalties up to $11,000 per false claim and would have to repay Medicare and Medicaid three times the amount of the government’s loss for the fraud.

The Enquirer reports that the inadequate care included failure to update resident care plans, failure to follow doctors’ orders, failure to treat wounds and pressure sores, and failure to monitor the blood sugar levels of diabetic residents. Additionally, the suit claims that the nursing home was not properly staffed at times, and that the staff was negligent in bathing residents for many days on end.

This is the first suit filed in Kentucky that accuses a nursing home of defrauding Medicare and Medicaid by submitting bills for reimbursement for providing consistently poor care to residents.

I wish more states would seek reibursement from national chains that promise quality care but deliver neglect to residents.

See full article at Third Age.