Illinois Nursing Home Abuse Lawyers Blog

Nursing home negligence lawyers at Pintas & Mullins point to a troubling new study published in the Annals of Surgery detailing the risk of abdominal procedures in nursing home residents. Compared to seniors of the same age undergoing the same surgical procedure, nursing home residents experienced substantially higher rates of mortality and invasive interventions.

The study compared mortality rates for four types of abdominal surgery in elderly patients, which included surgeries for: bleeding ulcers, burst appendix, infected gallbladder, and noncancerous colon diseases such as colitis or diverticulitis. These conditions were chosen because they require immediate corrective surgery, opposed to diagnoses like lung cancer that enable patients to take a longer amount of time to consider treatment options.

Researchers used nursing home surveys and national Medicare claims to track more than 70,000 nursing home residents who underwent one of those four surgeries between 1999 and 2006. They then compared these patients' outcomes with more than one million seniors who did not reside in nursing homes but underwent the same abdominal procedure.

After an appendectomy, 12% of the nursing home residents died, compared to only 2% of other Medicare patients not in an assisted living facility. Similarly, nursing home residents undergoing gallbladder surgery died at a rate of 11%, compared to 3% of their senior counterparts.

Troublingly, mortality rates rose sharply for the other two procedures. Nearly one third of patients from nursing homes undergoing colon operations passed away, while only 13% of the other elders did. Ulcer procedures were by far the most dangerous, with a mortality rate of an astonishing 42% in institutionalized elders and 25% of the others.

Dr. Emily Finlayson, the study's lead author, stated that, even when they matched the two groups by specific age and number of diseases, those patients living in a long-term care facility still had significantly higher mortality rates. She offered that this may be because those institutionalized patients do not have the strength and mobility to live independently, which extends to their energy and vitality, and ultimately, their physiology.

Even those patients who survived the initial surgery, however, were not complete success stories. Nursing home residents were far more likely to have to undergo invasive interventions after the procedure, meaning they needed machines to help them breathe for days afterward, feeding tubes, and/or venous catheterization.

A substantial number of elders who are hospitalized for procedures will never again function at the same physical or mental levels, even if their initial malady is successfully treated. Surgeons and hospitals consider a procedure a success if a patient leaves the hospital alive - regardless of what happens in the near future. With elders, however, the emphasis should be treating illnesses with the least-invasive methods, instead of with what is conventional for patients half their age or with twice their vitality.

The U.S. Preventive Services Task Force, upon reviewing years of research, recommended that adults over 75 years of age should not screen for colorectal cancer. It has been reported by several institutions that colonoscopies are significantly overused in the elderly, with increasingly damaging consequences. Colon cancer develops very slowly, so, to put it bluntly, most patients over the age of 80 will not live long enough to benefit from a colonoscopy, which is risky in itself.

Continue reading "Surgeries Increasingly Dangerous in Nursing Home Residents " »

Nursing home negligence lawyers at Pintas & Mullins report that, according to information obtained from ProPublica, the states with the highest number of average serious deficiencies per home are Kentucky, Louisiana, Arkansas, and South Carolina. Texas has the highest number of total serious deficiencies.

ProPublica collected information from Medicare and Medicaid inspections from the past three inspection cycles, which occur every 12 to 15 months. Medicaid rates the deficiencies on a scale from A to L, with the most serious given a J, K, or L rating. The database details about 118,000 issues in more than 14,500 nursing homes.

The facility with the highest number of fines is Princeton Health and Rehab Center, located in Princeton, KY, which is listed as a Special Focus Facility. The nursing home was fined more than $560,000 in 2012, with a total of seven deficiencies and a J rating. The Medicare Survey Report detailed troubling incidents that occurred at the home in that year, at least one of which resulted in a resident's death.

In one incident, a nurse administered a resident pain medication at 2 am. At 4 am, staff helped the same resident sit up on the side of the bed, and then left the resident alone in the room. The resident subsequently fell from the bed, suffering extreme internal bleeding in the brain. The resident died from this internal bleeding, which was listed as the determining factor on the death certificate. In Princeton's investigation, it failed to identify that the staff did not provide adequate care and supervision to prevent the accident.

Another Kentucky facility, Johnson Mathers Nursing Home, is listed as having some of the most serious deficiencies in the nation, also noted as a Special Focus Facility. This nursing home has been subject to seven inspections between June 2010 and November 2012, racking up astounding 54 deficiencies in those two years. In a 2011 report, at least one resident claimed to have been sexually abused in the nursing home, and investigators determined that the facility failed to have an effective program in place to prevent abuse.

The resident alleged that she had been raped, however there was no documentation showing the facility ever completed an investigation into the incident, took action to protect the resident, or notified local law enforcement.

Instances of resident neglect and abuse are the result of a number of factors, but none are as evident as the pursuit of profits over patients. Many nursing homes, not only in Kentucky but across the United States, bill Medicare and Medicaid for unnecessary, and often dangerous, services in order to gain reimbursements. An Erlanger nursing home, Villaspring Health Care and Rehabilitation, was recently ordered to pay the federal government $350,000 and enhance its standard of care due to False Claims Act allegations.

Between 2004 and 2008, Villaspring provided unnecessary services and fraudulently billed the government for them, which ultimately resulted in five patient deaths, in order to receive federal reimbursement. Some of the deceased patients went several days on end without baths, suffered from dehydration, and sustained severe bedsores that led to fatal infections.

In one case, a woman was admitted to Villaspring after a surgery on her hip, though she was otherwise alert and continent. The facility, however, put her on adult diapers, and she developed bedsores so severe that her left leg had to be amputated. She ultimately died of a blood infection, just four months after being admitted.

Continue reading "Kentucky has Highest Number of Nursing Home Deficiencies " »

A jury recently ordered a nursing home accused of fraudulent billing, among other illegal practices, to pay more than $28 million in penalties. The case was filed after two former employees of the facility came forward with the information. Nursing home negligence lawyers at Pintas & Mullins remind the public that whistleblower cases such as this are critical in exposing and solving senior abuse and neglect.

During the nine-day trial, it was revealed that the nursing home - Momence Meadows Nursing Center - billed more than 1,700 false claims to Medicare and Medicaid. The facility operates as a for-profit nursing home, as most in the United States do.

It is an unfortunate reality that the national increase of for-profit nursing homes is significantly affecting patient care. Those facilities that focus solely on making profits are much more likely to bill the government for unneeded care or for treatment it never administered. According to a recent Bloomberg article, 70% of American nursing homes are run by companies whose main objective is to make money, and 78% of the annual income for nursing homes in 2010 - $105 billion - was enjoyed by for-profit homes.

This marks a six percent increase in profits since 2002. 30% of the billing claims from for-profit nursing homes were considered improper by federal health care inspectors, compared to only 12% of improper billing by non-profits. This article, along with data from Medicare overseers, supports the argument that the national rise of for-profit facilities is also spurring a rise in wasteful, fraudulent, and harmful health care.

Non-profits simply do not have the incentive or need to fraudulently bill, under-staff, or neglect patients. For-profits are owned largely by investors, and their facilities earn a 20% profit on Medicare patients, compared to non-profits, which earn about 9% on those patients. For-profits also employ about 37% less registered nurses per resident, and received almost 60% more deficiency warnings from inspections than non-profits.

The effects of this troubling trend were evident at Momence Meadows Nursing Center, which is why two of its former employees reported the fraudulent behavior to the federal government, who sued the facility under the False Claims Act.

The two employees accused the home of giving grossly inadequate care to its elderly and disabled residents. This substandard care directly led to the deaths of three patients and severe bedsores in countless others. Bedsores become a problem when nursing home staff is so overworked or understaffed that they cannot adequately care for each resident as they require it. Some nursing home residents are bed-ridden or unable to move around without assistance. If they are not moved or turned every few hours, pressure ulcers start to form, and can become infected if not treated immediately. Bedsores that get infected can lead to sepsis, which can ultimately result in death.

The nurses also alleged that Momence Meadows directed them to falsify records for patients and medications to say that care and treatment was given when it was not. Additionally, they were asked to falsify staffing records to indicate that minimum staffing levels had been met, although they had not been. They were also told to re-edit patient charts to conceal events that led up to patient's injury, illness, and even death.

The workers brought their claims against the facility in 2004, and after their complaints were revealed, they were retaliated against by the facility with threats, verbal abuse, and preventing other facilities from hiring them. Once the government sued the facility under the False Claims Act, however, the employees were fully protected under Qui Tam, or Whistleblower, laws. These laws protect whistleblowers from retaliation and also enable them to recover monetary damages from the verdict, usually around 15 to 25% of the penalties.

Continue reading "Illinois Nursing Home to Pay $28 Million in Whistleblower Case " »

Each year, U.S. News teams up with Nursing Home Compare, a federal website that collects information from all nursing homes that accept Medicare and Medicaid, to create a database of the nation's best and worst assisted-living facilities. With an estimated 3.3 million Americans currently residing in nursing homes, collected information of this type is extremely valuable for those already with loved ones in nursing homes or trying to choose the best facility.

Selecting a nursing home for a loved one can be difficult and trying in all aspects, which is why the Centers for Medicare and Medicaid (CMS) rate all nursing homes that accept Medicare on a five-star system (nearly all facilities accept the federal program). The agency's report also outlines of the nine warning signs of poor or negligent care, and provides information on how to cover the costs and methods on how to choose the ideal facility.

CMS rates nursing homes based on a number of elements, based on state surveys, inspections and investigations, which are conducted at least every 15 months in each individual facility. The three main areas taken into consideration include: health inspection reports, nurse staffing, and quality measures.

Health inspections are conducted by state surveyors, who examine factors such as safety of food preparation, adequacy of infection control, medication management, and resident's rights. Ratings in this category are based on the number of noted deficiencies, their seriousness, and how many residents could potentially be affected by the deficiencies. This category is extremely important in determining the standard level of care administered at facilities.

Quality measures are based on the percentage of residents who received care such as flu vaccinations, and the percentage of residents who suffered from excessive pain, bedsores, UTIs, and other care-related problems. Nurse staffing rankings are calculated by averaging the number of hours per day residents receive care from nurses at all levels. To receive five stars in this category, a facility must provide its resident with at least four and a half hours of nursing care each day.

Of the 16,000 facilities in the country, only about 3,000 received an overall rating of five stars. Four states, along with the District of Columbia, had fewer than ten top-rated nursing homes: Alaska, New Mexico, Vermont, and Wyoming.

Although CMS ratings of one or two stars are not enough to prove that your loved one is being inadequately cared for, it is certainly a red flag. United Medical Nursing Home in Washington D.C., for example, received one star in all categories except quality measures, in which it received three stars. The report details exactly what elements of all three categories contributed to the poor rankings, the level of harm afflicted by these deficiencies, the number of residents affected, and on what date the deficiencies were fixed.

For example, this particular Washington D.C. facility was noted for failing to make sure that each resident's medication regimen was free from unnecessary drugs, and failing to manage and monitor each resident's regimen. Overmedicating and wrongfully medicating residents is a serious form of elder abuse. Too often, understaffed facilities unlawfully medicate residents - using dangerous anti-psychotic drugs - to sedate unruly residents, or to manage residents who need more care. According to the FDA, over 15,000 nursing home residents pass away each year from medication errors.

In another example, Warren Barr Pavilion in Chicago, IL received four stars for quality measures, three for nurse staffing, and one for health inspections, leading to an overall rating of one star. Health inspection records showed that many, if not all residents were negatively impacted by the deficiencies.

Continue reading "The Best and Worst Nursing Homes in America" »

Senior abuse and neglect lawyers at Pintas & Mullins recently reported about changes in Wisconsin tort reform laws that prohibit plaintiffs from using state investigation reports in court. Victims of abuse and neglect are also facing major hurdles in obtaining justice for their suffering, as nursing home employees are increasingly failing to report injuries and mistreatment, which is required by federal law.

Even more alarming is that states rarely punish nursing homes for this failure. One such case involved a 65-year-old woman, Kathy Witt, who was a resident at Wisconsin's Mayville Nursing and Rehabilitation Center. Among other physical ailments, Witt suffered from severely low blood pressure, which caused extreme dizziness whenever she stood or sat up. One day, Witt was in her bed and pressed the call light to have a nurse help her get up. She waited for help for a number of minutes, finally deciding to stand up unassisted. She fell, hit her head on the floor, and died a few days later.

Mayville and all other nursing homes with Medicare and Medicaid beneficiaries are required by federal law to report incidents of alleged mistreatment, neglect and abuse - including injuries from unknown derivation - within 24 hours. The Wisconsin home, just like thousands of others throughout the country, never reported the accident that led to the resident's death, and there are currently no plans to discipline Mayville for that failure.

In another case, KindredHearts, located in Green Bay, Wisconsin, failed to report a 2008 resident death. The death was reportedly caused by employee neglect. Assisted living facilities and nursing homes not taking Medicare and Medicaid have seven days to report incidents such as this, after which the state may step in to investigate the facility.

One such investigation resulted after the Sunrise Care Center in Milwaukee failed to report a resident's fall that resulted in a fractured hip. The state determined the fall occurred because of negligence, and cited the facility for failing to report, failing to develop plans to prevent neglect and abuse, and failing to follow resident care plans.

Experts say that this type of failure is far from uncommon, and recent news reports confirm this troubling fact. More often than not, state healths departments only learn about incidents of abuse, neglect and mistreatment after a family member or the resident themselves file a complaint. Therefore there is no way to possibly know how many incidents go unreported. In one study, 10% of nursing home nurses reported that they had committed one or more acts of physical abuse in the past year, 40% admitted to committing psychological abuse, and 14% reported seeing abuse and neglect in their facilities every day.

Neglecting residents is an insidious and often fatal form of abuse. In Minneapolis, for example, a nursing home employee did not administer CPR to a resident during his final breaths. Earlier that day, the resident suffered from a vomiting episode and the same employee failed to notify the resident's doctor. This was the second death within two weeks involving nursing home employees failing to administer resuscitation and neglecting to properly document incidents.

Continue reading "Nursing Homes Fail to Report and Take Action to Save Resident Lives" »

Nursing home abuse and neglect lawyers at Pintas & Mullins highlight a recently published study outlining the changes in end-of-life-care for Medicare beneficiaries. The findings illuminate issues surrounding sites of passing, places of care, and the health care transitions that our nation's seniors made in their final days.

The article, published in the Journal of the American Medical Association, described these changes as they occurred between 2000, 2005, and 2009. The patients examined in the study were aged 66 years and older, and were classified as diagnosed with pulmonary disease, dementia, or cancer, in the last 180 days of their lives. In total, nearly 850,000 patients were evaluated.

There was a significant increase in the percentage of seniors dying at home, from 15% in 1989 to 24% in 2007. Other changes in the "site of death" percentages included 7% more passing away in nursing homes and 14% less passing in acute care hospitals. The use of hospices and palliative care services also expanded, which may prove that these systems are successfully aiding our nation's seniors at the end of their lives.

Hospice care systems are designed to provide coordinated, team-based, patient-centered comfort care to those with terminal illnesses. When functioning at their peak these systems reduce unnecessary hospitalizations, therefore saving healthcare dollars. Between 2007 and 2011, the number of patients receiving hospice care increased by 16%, to 1.65 million Americans. Hospice systems are a $14 billion dollar business, and Medicare is billed for about 84% of the services. Traditionally, hospice care was reserved primarily for cancer patients, although in recent years, more and more enrolled patients have illnesses such as heart disease and dementia.

The use of hospice services at the time of death increased steadily throughout the years studied. In 2000, the rate was about 22%, in 2005, it was 33%, and in 2009 the rate was at nearly 43%. This indicates that the hospice system is doing something right, as more and more patients are asking to be enrolled and spending their last days there. However, nearly 30% of those patients were only enrolled in hospice for three days or less before passing.

This late-stage enrollment points to an important issue, perpetuated by the fact that patients were more likely to be hospitalized in the final three months of their lives, and were more likely to spend time in the ICU. Additionally, transitions between healthcare institutions in the last 90 days of life increased 50% between 2000 and 2009, from an average of two to an average of three, and 14% were forced to transition in their last three days. More than 11% were hospitalized three or more times in their last 90 days, and, most disturbingly, patients with dementia spent considerably more time in the ICU in 2009.

So, what do these figures mean? They confirm that American seniors are not given patient-based comfort care until their illnesses are extremely advanced. The majority stay in nursing homes for years, with minimum care, and are subjected to numerous transfers between healthcare facilities in their last days. Nursing home residents often suffer from chronic illnesses, and death is usually able to be projected. So why are 30% of seniors not enrolled until their final three days? Many more studies need to be conducted to find the answer.

Continue reading "De-Coding Changes in End-of-Life Care " »

Nursing home abuse and neglect lawyers warn that wrongdoing is once again being exposed at Lexington Health Care of Orland Park, Illinois. In 2011, a Lexington employee was charged with sexually assaulting a resident after a co-worker caught him in the act. The whistleblower is now suing Lexington for wrongful termination.

The man accused of assaulting a Lexington resident was Robert Phelan, who was arrested and charged with aggravated criminal sexual assault in 2011. The investigation began after a co-worker saw and reported inappropriate contacts between Phelan and a 93-year-old Dementia patient. The case involved witness testimonies and a sexual assault examination from a local hospital. If convicted, Phelan could face up to 30 years in prison.

The supervisor who reported the assaults was terminated in 2012. She believes that she was fired for exposing Phelan's criminal acts, and in now suing Lexington Health Care for wrongful termination.

These are not the first reports of wrongdoing on the part of Lexington. The facility was subject to Illinois Health Department investigations in December of 2010 and April of 2011. The investigations revealed serious deficiencies, including numerous reports of residents with suspicious bruises. One 87-year-old female resident had four troubling bruises, on her face, left cheek, breast, and thigh. According to the report, the resident was unable to describe the events resulting in the bruising and was unable to communicate feelings of pain. Inability or reluctance to speak about abuse and neglect is a major sign of criminal actions.

The investigations revealed that Lexington failed to both contain a scabies outbreak and report it to the local health department. Staff did not adequately wash infected bed linens or apply medical creams to affected residents. There was also an extreme failure by staff to acknowledge and treat advanced stage bed sores. One resident reportedly suffered from two open sores and screamed to the investigators that he was in pain while the nurse ignored him. The resident's open sores were the size of a silver dollar and a quarter. Among the most troubling Lexington complaints included a level four failure to write and use policies that forbid mistreatment, neglect, and abuse of residents. Level four violations are the highest possible, indicating immediate jeopardy to the health and safety of residents.

Other violations included frequently and knowingly mixing wrong medications and several incidents of unmonitored and life-threatening falls. The facility was last inspected in March of 2012, during which six health deficiencies were reported. The most recent report revealed that Lexington failed to ensure that the resident environment was free of potential hazards. Inspectors found an unattended cart left open with tools and chemicals fully exposed. A medication cart was also left unattended with the top drawer fully open. The facility currently has 2 out of 5 stars in an overall Medicare rating.

Continue reading "Troubling Reports from Lexington Health Care of Orland Park " »

The so-called Fiscal Cliff Agreement that passed through Congress on New Year's Day includes a compromise bill that may affect long-term care services. Nursing home abuse and neglect attorneys highlight this compromise bill, which repealed the CLASS Act and created a new federal commission to submit a proposal for financing and delivering long-term care needs.

To those paying attention, the repeal of the CLASS Act is long-awaited. The Obama Administration abandoned the Act not long after its 2010 creation and it had no champion in Congress. It was a faction of the health care reform law, and was initially intended to create a new, nation-wide, voluntary, long-term care insurance system. In reality, the CLASS Act's premiums were too expensive for most and did not inspire employer participation.

The fiscal cliff bill, which is actually called the American Taxpayer Relief Act, may be critical to those receiving long-term support and their caregivers, and included 29 further provisions affecting Medicare, Medicaid and other healthcare programs. It traded the CLASS Act for the creation of a national long term care commission, which is expected to design and submit plans for the establishment, financing, and delivery of a comprehensive long-term services system, both for those currently in need of these services and those planning for future needs. The idea of such a commission was pushed for many years by West Virginia Senator Jay Rockefeller (D).

The commission will include 15 members, appointed by the White House as well as bi-partisan leaders of the House and Senate. Members are expected to reflect the interests of care recipients and their caregivers, long-term care insurance companies, state Medicaid administrators, and other care workers and providers.

According to Forbes, however, there are numerous elements of this commission that are extremely disconcerting. First is the extraordinarily limited time frame - panel members have to be chosen within a month, and a comprehensive proposal must be submitted within six months after that. Second, the commission will not be connected to any federal agency, which potentially avoids any bureaucratic politics, although it also means that the commission has no automatic supporters within federal entities. Lastly, and arguably most importantly, the bill does not require Congress to ever actually vote on the recommended changes. This is, apparently, an old political trick, which usually shelves commissions and their proposals, never to be seen or heard from again.

Continue reading "Fiscal Cliff Deal Includes Changes to Elderly Care " »

Experts and researchers have maintained for years that federal fines vary tremendously from state to state. This disparity may be an indication that government oversight is lacking in our nation's nursing homes. Senior abuse and neglect attorneys are concerned that the quality of care in nursing homes is compromised by this lack of oversight.

ProPublica, a non-profit investigative journalism group, recently requested information from federal nursing home inspections and released this information in a comprehensive online database. The information encompasses deficiencies cited by U.S. Centers for Medicare and Medicaid (CMS) regulators and the penalties imposed over the past three years. The tool also allows visitors to use terms and keywords to search nearly 60,000 nursing home inspections for trends and patterns. One of the major issues illuminated in this database are the immense differences between state penalties, and the inconsistency with which these penalties are imposed.

This disparity is evidenced through two case reports of resident deaths, one in Texas and one in South Carolina. In 2012, a resident of a Hughes Springs, Texas nursing home died while choking on a cookie. The man approached the nurses' station several minutes before he died, obviously choking. The facility staff did not immediately call 911, and attempted but failed to clear the man's airway numerous times.

Just a few months earlier, a woman in a North Augusta, South Carolina nursing home pulled her breathing tubes out and died of asphyxiation. Federal inspectors faulted the facility for failing to take appropriate measures to keep the woman from injuring herself. Apparently, the women had pulled out the breathing tubes seven additional times in the months before her death.

Government officials found that the Texas home did not have policy and procedures for a medical emergency, and staff was not trained for emergency procedures. Emergency carts were not stocked with proper equipment and were not readily available. The facility remained out of compliance at a pattern of actual harm, with the potential for more than minimal harm. These failures contributed to a delay in emergency intervention that contributed to the resident's death.

Inspections at the South Carolina facility indicated many of the same deficiencies. Although the woman was made to wear mittens to prevent her from pulling out her breathing tubes, the facility failed to adequately assess her for the effectiveness of those restraints. She was, apparently, able to easily remove the mittens, which she had demonstrated several times in the months before her death. The Attending Physician agreed that there were more interventions that could have been initiated.

In both cases, Medicare and Medicaid Services (CMS) cited the homes for numerous failures that put resident safety in immediate jeopardy. The consequences, however, were severely different. Texas state officials recommended a fine of $9,500 for the incident, to which CMS officials agreed. In the South Carolina facility, state officials determined the home should be fined upwards of $305,000, to which CMS again agreed. This is a difference of hundreds of thousands of dollars, for relatively the same deficiencies that resulted in resident asphyxiation.

Continue reading "Troubling State Disparities between Nursing Home Fines " »

Although an immense amount of trust is placed in American nursing homes, our nursing home negligence lawyers recognize that some, particularly for-profit facilities, are prioritizing profit margins over patient care.

A recent article in Bloomberg News revealed many troubling issues posed by our country's nursing homes. The article cited November reports by federal health care inspectors from the U.S. Department of Health and Human Services, which found that each year the nursing home industry over-bills Medicare $1.5 billion for treatments patients who either never receive or never needed care in the first place. In 2011, Medicare spent nearly $32 billion on skilled nursing facility care. That year, 70 new facilities began participating in the Medicare program, almost all of which were for-profit homes.

We should be able to trust nursing homes throughout the country are focused on a common goal: to provide the best possible care for their patients. Federal and investigative reports, however, speak to the contrary. Much research proves that for-profit nursing homes are significantly more likely to pursue monetary gain than non-profit ones, even at the expense of elderly clients. A reported 78% of the nursing home industry revenues went to for-profit facilities in 2010, even though they account for only about 67% of all nursing homes.

What is troubling about this trend is the rapid growth of for-profit nursing homes in the United States. For example, the supply of hospice care increased 53% between 2000 and 2010, and for-profit providers accounted for almost the entire increase. That is a ten-fold growth over non-profits. For-profits also operate 85% and 84% of dialysis clinics and home-health care agencies, respectively.

A 2012 report by the Medicare Payment Advisory Commission, or Medpac, from which many of these figures are cited, stated that they did not have sufficient data to assess the quality of hospice care provided to Medicare beneficiaries. During the past three years, however, the U.S. Justice Department settled civil fraud complaints against eight hospice companies that were enrolling or retaining patients who did not need hospice care. Avoidable hospice admissions increase Medicare's spending, expose beneficiaries to additional disruptive care transitions, and can result in adverse health consequences.

The supply of hospices increased 53% between 2000 and 2010, and for-profit providers accounted for nearly the entire increase. The report cited a lack of sufficient data to assess the quality of hospice care provided to Medicare beneficiaries.

Medicare's rules allowed facilities to bill for therapy that was not provided. Under the old regulations, payments were determined by assessing each patient during a limited window of time, but this assessment is used to establish payments over a longer period of time. Until recently, Medicare rules did not require facilities to reassess patients when their therapy care needs changed and the program did not reconcile payments with the actual amount of therapy provided.

Unnecessary medical treatment can be extremely harmful, especially for the elderly. Employees of large nursing home chains are speaking out about this issue, affirming that they feel encouraged to maximize reimbursement even when treatment is inappropriate.

Billing for unneeded therapy is neither the worst nor the most dangerous of the profit-seeking schemes, however. Between 2003 and 2008, the 10 largest for-profit nursing homes chains in the nation employed 37% less registered nurses per patient, and received almost 60% more deficiency notices from federal inspections, than non-profits. This fact illuminates the stark reality of for-profit facilities - that they are actively and intentionally sacrificing patient care to put more cash in investor's pockets.

Continue reading "For-Profit Nursing Homes Overcharging Medicare as Residents Suffer" »

A troubling report surfaced in the Chicago Tribune yesterday of a local psychiatrist submitting fraudulent claims to Medicare and Medicaid. Dr. Michael J. Reinstein of Community Mental Health Services in Uptown is accused of accepting illegal kickbacks from pharmaceutical companies for anti-psychotic medication prescriptions. Specifically targeting nursing home residents, Dr. Reinstein has been under investigation for these suspicions since 2009. Nursing home negligence lawyers at Pintas & Mullins warn of the devastating effects of overmedication. Dangers of such medical malpractice are exponentially increased in cases of the elderly. If you suspect any negligence of this kind, contact our office immediately to discuss you potential claim.

According to the report filed by the U.S. attorney's office, Dr. Reinstein submitted at least 140,000 false claims regarding these anti-psychotic drugs, and an additional 50,000 claims of pharmacologic management, which were also fraudulent. Dr. Reinstein is responsible for the care and well-being of nursing home residents in over 30 facilities in the Chicagaoland area, making this the largest prescription medication fraud case ever filed against a single individual in Chicago.

Dr. Reinstein regularly administers drugs such as Clozaril, which is an FDA schedule two controlled substance, and carries a 'black box' warning, the most severe for a prescription medication. The overmedication of patients, particularly elderly patients, is not only immoral and illegal, but life-threatening as well. Clozaril is a drug for victims of schizophrenia, and is associated with heart failure and seizures, and requires very strict monitoring, including blood tests every two weeks. Numerous local and international studies report of rapid death from the use of this medication, which Dr. Reinstein administers more often than all top doctors in Texas, North Carolina, and Florida combined.

A graduate of Northwestern University's Feinberg School of Medicine, Dr. Reinstein is a Healthgrades Recognized doctor. He has practiced in the Chicago area for nearly forty years, and receives consistent reimbursement from the federal government for servicing an unusually large amount of patients.

Pharmaceutical companies are widely known to compensate doctors who prescribe their products in large amounts. Novartis, the manufacturer of Clozaril, is no exception. Dr. Reinstein is far and away the largest prescriber of Clozaril, which was taken by more than 1,000 of his patients at any given time for many years.

In July 2003, Novartis ceased manufacturing of Clozaril and consequently their payments to Reinstein. Less than one month later, Dr. Reinstein approached Ivax Pharmaceuticals, who manufacture a generic form of the drug, offering to prescribe their product if they agreed to pay him $50,000 per year (under a 'consulting aggreement'), paid his nurse to advocate for the drug, and fund a clozapine research study. Ivax agreed to the arrangement, and Reinstein became the largest prescriber of their product in the country. According the Tribune article, Reinstein had 75% of residents prescribed to Ivax's clozapine at one local nursing home. Reinstein is also a top prescriber of Seroquel and Haldol, two other anti-psychotic medications.

The civil case filed against Dr. Reinstein regards the fraudulent claims made to Medicare and Medicaid, however, not the pharmaceutical company payoffs. The lawsuit is seeking damages under the False Claims Act, in addition to a penalty of $5,500 - $11,000 for each false claim, of which there are at least 190,000.

Continue reading "Chicago Nursing Home Doctor Faces Federal Lawsuit " »

The re-election of President Obama illuminated a country that is divided; not only on social issues, such as abortion and marriage rights, but on healthcare reform and federal deficit plans as well. GOP candidate Mitt Romney ran on a platform calling for the full repeal of the 2010 Patient Protection and Affordable Care Act and Medicare reform. The President's re-elections means that healthcare overhaul will move forward in all 50 states, including battleground states like Ohio, Pennsylvania, Iowa, and New Hampshire.

The 13 states that waited to apply the Affordable Care Act in anticipation of Romney's campaign now have until November 16 to provide plans on how to manage the new provisions. Governors who do not meet the deadline will nevertheless see the government create a more organized and competitive health insurance market for them, through the creation of exchanges.

A health insurance exchange can be either a government agency or a non-profit organization, and will serve those buying insurance individually as well as businesses with less than 100 employees. These state-based health insurance exchanges are a key component of the Obama administration's Affordable Care Act. The exchanges are expected to be up and running by 2014, at which time the government will provide subsidies to make coverage more affordable. Nursing home lawyers at Pintas & Mullins emphasize the importance of the Affordable Care Act with respect to long-term care for the elderly, who rely on Medicaid for medical aid and services.

Insurance companies will be expected to offer coverage regardless of preexisting conditions, which means they will no longer be allowed to deny or charge more because of sickness. They will be expected to collect data and meet quality and reporting standards, as well as cover a percentage of enrollment costs.

Alan Weil, the executive director of the National Academy for State Health Policy, adds that there are a few options for how states will develop the exchanges: they can do it on their own, share responsibility with the federal government through a partnership arrangement, or leave it entitled to the government to handle. Exchanges are expected to begin enrollment by the fall of 2013, less than one year away.

Currently, nearly 50 million Americans are enrolled in Medicare. President Obama intends to cut over $716 billion from Medicare spending over the next ten years, which will not impact Medicare eligibility or benefits. The President plans to eliminate wasteful spending within the healthcare system and insurance companies.

The Associated Press reported on the reality of President Obama's Medicare shifts, which includes the increasing of monthly premiums for seniors making $85,000 or more and a slight increase in annual outpatient deductibles for baby boomers. President Obama also faces the challenge of raising the eligibility age for Medicare, a stance firmly held by Romney, from 65 to 67.

Continue reading "A Second Obama Term Brings Healthcare Reform for Seniors " »

Florida seniors' Medicare-funded nursing home care will face new $60.5 million payment reductions, according to a recent news report. These cuts are part of the Middle Class Tax Relief and Job Creation Act of 2012m which was passed earlier this year.

The nursing homes or skilled nursing facilities (SNFs) that are facing the biggest Medicare cuts include: Florida $60.5 million; Ohio $30.5 million; Illinois $28.8 million; Pennsylvania $24.2 million and North Carolina $22.6 million.

In August 2011, the Centers for Medicare and Medicaid Services (CMS) reduced Medicare nursing facility payment rates by 11.1 percent. Congress slashed the reimbursement for Medicare co-payments not made by beneficiaries or Medicaid programs in the various states.

As Chicago nursing home abuse lawyers, we are deeply concerned about the impact that these new Medicare cuts will have on the country's already troubled nursing homes. The Alliance for the Quality of Nursing Home Care points out that such payment cuts will lead to layoffs in nursing homes and cancel projects that will create new jobs.

A recent survey revealed that up to one-third of nursing facilities planned to give the pink slip to registered nurses, licensed practical nurses, certified nursing assistants, and therapists. This appears to be unavoidable, as labor expenses make up about 70 percent of the facilities' costs. The report also revealed that over 70 percent of the nursing facilities planned to change wage rates, about 50 percent planned to change benefits, and about 23 percent said they plan to delay or cancel opening new facilities.

The lack of skilled nursing caused by such lay-offs will affect the quality of nursing care for Medicare post-acute care patients and Medicaid-funded long-stay residents. This, in turn, will result in unnecessary re-admissions and drive up Medicare costs.

In response to Medicaid cuts in the past, skilled nursing facilities reduced nursing hours per resident. This led to an increase in the number of adverse medical events each year, such as falls, sores and infections. The cuts have also reduced the number of nursing facilities by endangering their financial stability.

Medicare payment reductions may also inadvertently widen the gap in quality of care across nursing facilities, or even between Medicare and private patients within the same facility. Unfortunately, nursing home neglect and abuse are serious issues that older Americans face in nursing facilities. With the reduction in the number of nursing staff due to Medicare cuts, these problems are bound to increase.

Seniors discharged from hospitals and looking for rehabilitative care may find it difficult to find nursing facilities that will accept them. This is because the reduced Medicare cuts may discourage nursing homes from taking in expensive cases for which they could lose reimbursement.

Continue reading "Nursing Homes Nationwide Hit by Major Medicare Cuts" »

In a serious effort to reduce the ever increasing reports of nursing home abuse and neglect, the federal government has finally started to step in and take extreme measures. Most recently the federal government levied two immense penalties against two nursing home corporations based in Iowa. While it is too soon to determine if these penalties will actually deter nursing home abuse and neglect, it is likely to be successful for the same reason large jury awards have a deterrent effect. Our Illinois nursing home abuse and neglect attorneys are extremely experienced with obtaining the largest damage awards for our clients.

The recent sanctions were levied by the United States Department of Health and Human Services because the two corporations violated several nationally enforced regulations. The violation that resulted in the largest fine was the employment of workers who were barred from working in federally funded nursing homes. Even though there are not many federal regulations that are actually enforced, this regulation is consistently enforced.

The rationale behind this regulation is it's important to maintain at least a minimum standard of care. Once an employee has broken a rule and been barred from working at a federally funded nursing home, via Medicaid or Medicare, they are no longer allowed to work in the field in any capacity. This regulation also requires that nursing homes and health care facilities have a certain percentage of certified nurses and elderly care providers.

Continue reading "Big Federal Penalties Aimed at Deterring Nursing Home Abuse" »

Illinois nursing home lawyers at the Law Firm of Pintas & Mullins understand the decision to place a loved one in nursing home care is quite difficult. Families of elderly nursing home residents must trust that the nursing facility will provide essential services and adequate supervision. Unfortunately, some of the nation's largest for-profit nursing homes are still being cited with a high number of deficiencies related to resident neglect and abuse.

According to a recent release by the consumer group Families for Better Care, financial motivations explain some of the problems that seriously impact the health and well-being of vulnerable residents. In an effort to increase profits, many of the nation's leading nursing home chains are cutting back on labor costs. As a result, fewer skilled nursing personnel are available to assist residents with food and medication needs, or provide them with critical services such as bed sore prevention.

From a purely cost-savings standpoint, this strategy is effective. Year-end earnings statements show that several large, publicly-traded nursing homes experienced significant revenue spikes in 2011. Kindred Health Care reported an "exceptional" year, with operating revenues increasing from $4.4 to $5.5 billion. Annual revenues at AdCare jumped 200% to a record total of $151.4 million. And the Ensign Group nursing home chain reported "better than expected" operating results.

Several analysts predicted that the nursing home market would be negatively impacted by recent Medicare cuts that averaged about 11 percent. One study estimates that as many as 80 percent of nursing home residents rely on Medicare or Medicaid to provide for their nursing home care. Accordingly, adjusted Medicare reimbursement rates were expected to hurt the overall financial health of the nursing industry in 2011. Surprisingly, the balance sheets of many for-profit nursing homes reveal a far different reality. Nursing homes continue to thrive, and some facilities are even enjoying record revenue totals.

These figures suggest that deep staff cuts likely offset adjusted reimbursement rates, allowing nursing facilities to maintain a strong bottom line. Sadly, quality resident care is the only area on the decline. Studies show that inadequate staffing levels typically lead to higher deficiency rates. According to the journal Health Services Research, nursing homes with lower nurse staffing hours have the sickest residents. Some common deficiencies that residents typically suffer from include weight loss, falls, and serious mistreatment or neglect.

It is unacceptable to our Illinois nursing home negligence attorneys that far too many nursing home chains continue to emphasize profits over quality care. Some of the most serious safety violations are happening at the largest for-profit nursing facilities. Elderly and disabled residents are suffering from poor sanitary conditions, inadequate supervision, and a number of other safety-related deficiencies.

Continue reading "Strong Profits but Poor Quality of Care at Nation's Largest Nursing Home Chains" »