Tulsa World reported that an Oklahoma nursing home was fined $1.3 million for what the Oklahoma State Department of Health said is failure to stop a registered sex offender at the home from inappropriately touching other patients. The Enid News & Eagle reports that DHS notified Kenwood Manor of the fine and other sanctions on April 1.

“A health department official said numerous deficiencies were found at the home during a March 8 inspection that was triggered by an anonymous complaint. The department said the sex offender has inappropriately touched other patents and that the nursing home failed to implement its policy to prevent abuse.”

The U.S. Department of Health and Human Services reported that the HHS Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that a covered entity, Cignet Health of Prince George’s County, MD (Cignet), violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for violations of the HIPAA Privacy Rule. The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Read the Notice of Final Determination

Read the Notice of Proposed Determination

•Read the HHS Press Release

•For Information on OCR’s Enforcement Activities

The New York Times recently reported the settlement involving Accretive Health, one of the nation’s largest collectors of medical debt.   Accretive agreed to pay $2.5 million to the Minnesota state attorney general’s office to settle accusations that it violated a federal law requiring hospitals to provide emergency care, even if patients cannot afford to pay.  Accretive Health is also barred from contracting with hospitals within the state for at least two years, effectively ending its business at three Minnesota hospitals. For four years after that, the company will have to obtain permission from the attorney general before resuming business in the state.

Hundreds of Accretive’s internal documents outlined aggressive (and illegal) collection tactics, including embedding debt collectors in emergency rooms and pressuring patients to pay before receiving treatment.   Accretive Health e-mails and internal training manuals revealed that some Accretive employees were told to hound patients to pay outstanding bills and sometimes discouraged them from receiving care. The revelations have reverberated across the country because such aggressive tactics have become widespread at hospitals.


USA Today had a great article on all the different "taxes" in the Affordable Care Act.  Though ObamaCare is projected to raise more than $800 billion in taxes, fees and penalties over a decade,  40% comes from about 3.5 million households with adjusted gross incomes above $200,000.  Employers, insurers and health care providers are slated to fork over much of the rest.  Fewer than 10% of the nation’s 140 million tax filers are likely to pay more.  That leaves only a few taxes that will fall partially on some middle-income taxpayers:

•The tax that rendered the law constitutional, to be assessed on those who fail to buy mandated health insurance, could hit about 4 million people across all income brackets.  On the other hand, about 18 million people will get tax credits if they buy health insurance plans through new federal or state exchanges.

•About 7 million people could pay more because the law makes it more difficult to deduct medical expenses. People with lower incomes are less likely to itemize deductions.

•About 4 million workers could pay more because of a new $2,500 limit on flexible spending accounts, which can be used to shield medical expenses from taxation.

Taxes for health care law

•Tax on high-cost health insurance plans paid by health insurance companies.

•Annual fee on health insurance providers paid by health insurance companies.

•Increased Medicare tax paid by individuals making more than $200,000 a year or couples making more than $250,000 a year.

•Limited deductions for health expenses paid by individuals claiming $7,500 or more in health expenses.

•10% tax on tanning salon visits paid by people who use tanning salons.

•2.3% tax on medical devices that cost more than $100 paid by manufacturers and importers of medical devices.

•Higher tax on home sales for individuals who make more than $250,000 and couples who make more than $500,000 in profit on the sale of their homes.

"The Affordable Care Act is the largest health care tax cut in history," says Jason Furman, deputy director of the White House National Economic Council. "It will provide a significant net tax cut for middle-class families and the millions of Americans who will seek affordable insurance in the years ahead."

 It is doubtful that all these taxes will be implemented.


The L.A. Times reported the $1.1 billion fine imposed by a federal judge in Arkansas litigation against Johnson & Johnson after a jury found that the companies downplayed and covered up risks associated with taking the antipsychotic drug Risperdal.  Circuit Judge Tim Fox determined that Johnson & Johnson and subsidiary Janssen Pharmaceuticals Inc. committed nearly 240,000 violations of the state’s Medicaid fraud law — or one for each Risperdal prescription issued to state Medicaid patients over a 31/2-year period.  Each violation carried a $5,000 fine, the state’s mandatory minimum amount, bringing the total to more than $1.1 billion. Fox issued an additional $11 million fine for more than 4,500 violations under the state’s deceptive practices act, but he rejected the state’s request to levy fines in excess of the $5,000 minimum for the Medicaid violations.

Arkansas was one of several states to sue over Risperdal. A South Caroline judge upheld a $327-million civil penalty against J&J and Janssen in December 2011.  Meanwhile, Texas reached a $158-million settlement with the companies in January in which they didn’t admit fault.


The Hartford Courant had an article on the tragic death of a nursing home resident who choked on a peanut butter and jelly sandwich.  It was well known that the patient needed assistance while eating.  Because of short staffing, the resident was left unattended with the fatal sandwich. 

State inspectors said staff members at Torrington Health and Rehabilitation Center, whose parent company is Spectrum Healthcare Torrington, were required to carefully monitor the elderly patient, who suffered from mental illness and pulmonary disease. The staff was instructed by doctors to encourage the resident to eat slowly and take small bites, and to cue the resident to chew and swallow. Food had to be cut up in small pieces.  Despite this treatment plan, inspectors reported, "staff failed to supervise the resident when the resident was left unattended with a peanut butter and jelly sandwich.”

The patient was found unconscious. Medics performed CPR and the ambulance report indicated the resident’s airway was completely blocked with peanut butter. The patient died at a hospital of cardiac and respiratory arrest, and choking, according to the state Department of Public Health inspection reports.


A $5,800 daily fine has been imposed against Bristol Nursing Home in Tennessee.  New admissions were suspended for a couple of days but for some reason was reinstated.  The state also imposed a one-time $3,000 fine.   The federal fine of $5,800 was to be imposed until violations discovered in March have been corrected.  The Tennessee Department of Health suspended admissions effective April 13 but it only lasted 4 days. 

A complaint investigation and annual survey conducted at the licensed 120-bed facility between March 26 and March 31 revealed serious  violations in the areas of, "administration, performance improvement, nursing services and resident rights."

At the center of the substantiated complaint is a mentally impaired and vulnerable male patient who fights with other men and has been accused of sexually assaulting female patients.  The staff complained that it was difficult to supervise him because of inadequate staffing.  He was admitted to the nursing home Aug. 9, 2011, and became violent and more focused on female patients after his ex-wife died sometime in November 2011. At times, he mistook several of the female patients as his ex-wife and complained that she was running around with some male patients.

The report cited:

Two violent men who have punched, pushed and kicked at patients;
Failure to draft a plan of intervention or increased supervision for the two violent patients;
A lack of incident reports, investigations or interventions related to incidents involving the most violent man;
Failure to notify a patient’s doctor of elevated blood sugar and need for psychiatric help
“The facility’s failure placed all the residents on the … unit in an environment which was detrimental to their health, safety, and welfare,” the report states.


The Downey Patriot reported the $80,000 fine against Downey Care Center for inadequate care that led to the death of a patient.  According to a report by the state Department of Public Health, a patient at Downey Care Center went into a diabetic coma after the facility failed to check the patient’s glucose level, despite being aware of her history of diabetesAfter 29 days without blood glucose monitoring, her breathing became shallow and nurses could not obtain vital signs.

By then the damage was done.  The woman was "deeply comatose clinically consistent with brain death." Family members had to make the difficult decision to remove her breathing tube and she was pronounced dead. The cause of death was listed as septic shock, urosepsis, diabetic ketoacidocis and diabetes mellitus type II.

That is criminal neglect of a vulnerable adult.

The Daily Pilot reported that the Newport Nursing and Rehabilitation center is fighting a $100,000 fine that the California Department of Public Health has issued after a woman died on September 6, 2011 because of a preventable fall after she was left alone and unsupervised in the bathroom. Several nurses noted that the woman needed constant supervision.

The Department of Public Health found that the nursing home failed to properly supervise the woman causing the fall.  The nurse who was responsible for supervising the resident in the bathroom left her alone to go take a break.  Why wouldn’t she wait to take her break?  Where was the charge nurse?

Another employee of the nursing home found the woman face down on the floor.  Medics were able to briefly revive her but she remained brain dead and had a fractured spine.


Illinois’ The State Journal Register reported the $2,200 fine issued to North Church Nursing & Rehab for failing to supervise a patient who died from choking on food.  State officials recommended that federal officials level a separate, $7,600 fine against North Church, a 113-bed for-profit facility that previously was known as Golden Moments Senior Care Center.

According to the investigation report, the resident was eating a sandwich unsupervised when she began to choke and passed out.  She was pronounced dead in the Passavant Area Hospital emergency department about 6:45 p.m. Sept. 23.

In a similar incident, the state issued a $50,000 fine against the facility, then known as Golden Moments, for poor care connected with the Oct. 3, 2009, death of Adam Waeltz, a 74-year-old patient who choked on food.