Recently in Medicare Category

Medicare Star Ratings May Do More Harm Than Good

August 26, 2014

2454143641_00d9fa44e5_o.jpgChoosing a nursing home for yourself or a loved one can be among the most decisions difficult of your life. In a culture increasingly dependent on the internet, Medicare's nursing home ranking website is exceedingly popular. There are more than 15,000 nursing homes in the United States; trying to find the right one is overwhelming, which is why systems that rank facilities are so widely used.

Nursing home lawyers at Pintas & Mullins and throughout the country are concerned that these online ranking systems are actually causing much more harm than good. Here, we delve into this matter and the reality of Medicare's five-star system.

The New York Times recently published an in-depth, wonderfully written yet harrowing account of how Medicare's ratings allow nursing homes to cheat the system - and ultimately elderly patients. Although the five-start Medicare program is relatively new (it was established in 2009), it has become exceedingly popular. Consider this scenario: your elderly mother lives with you, and one day she falls and breaks her leg, requiring emergency surgery and rehabilitation. After surgery, the hospital gives you just one day to choose a rehab center for recovery. Pressed for time and overwhelmed by the situation, you turn to Medicare.gov for help.

This is exactly what happened to the Chandler family, of Sacramento, California, in 2011. Wanting to keep her close to home, the Chandlers placed their 90-year-old mother in Rosewood Post-Acute Rehab, which had a five-star rating on Medicare.gov. Like so many others, they did not know how the rating system actually worked, and the hotel-like appearance of Rosewood comforted them. They placed Essie May Chandler in Rosewood for a six month stay.

In her six months at Rosewood, Essie lost 40 pounds, fell 11 times, had massive bruising across her body, and broke both her legs. Another six months after she returned home to her family, she passed away. The Chandlers now live with this guilt, clearly unable to forgive themselves.

What Went Wrong


Medicare's ranking system is based on three factors: inspection reports, staffing levels, and quality measures. These last two criteria rely only on data the nursing home self-reports to the government; and the feds never go in to check if the numbers are accurate. Therefore there is not much deterring nursing homes from over-reporting and sending false data to Medicare to boost their ratings.

To say the basis of this system is incomplete or lacking would be an understatement. It seriously misleads consumers because of its flaws and because it does not account for important factors, like complaints filed, or fines and enforcement actions. If that information was factored in, it is unlikely Rosewood would have five stars; from 2009 to 2013, officials received about 150 complaints and reports of problems at Rosewood, which is twice the state average.

To investigate further, Times reporters interviewed current and former residents at Rosewood, most of who said they did not think the facility deserved a five-star rating. Many residents live in a room with two other people, the facility is understaffed, and basic supplies are scarce. Rosewood has also recently been named in about a dozen lawsuits (including several resident deaths) from families who accuse staff of mistreatment and substandard care.

When injured residents or their families sue nursing homes for negligence or abuse, they quite often have to go up against the nursing home's parent companies. Rosewood, for instance, is actually operated by North American Health Care, which also owns more than 30 other nursing facilities. This offers a glimpse into why Rosewood appears so well-run on the outside, but fails its residents so egregiously.

North American Health Care is a for-profit corporation, focused on pleasing investors and increasing the bottom line. The nursing home industry is made up primarily of corporations like North American Health Care, who own dozens, if not hundreds of nursing homes. Understaffing, failing to keep up with supplies, and overcrowding rooms actually help boost profits, though cause grave harm to residents.

Many nursing homes have expertly learned how to play the rating game - one analysis shows that even facilities with illustrious histories of inadequate care have high ratings in the self-reported criteria. Case in point: of 50 nursing homes on federal watch for poor quality, two-thirds have four or five stars for quality data and staff levels, while the state-reported health inspections earned them one or two stars.

Continue reading "Medicare Star Ratings May Do More Harm Than Good" »

Illinois Revokes License of Nursing Home Psychiatrist

August 13, 2014

78217195_07b2df9cdb_o.jpgA popular Chicago psychiatrist, Dr. Michael Reinstein, recently had his license suspended by the Illinois medical board due to his illegal prescribing of clozapine, an antipsychotic. He prescribed the dangerous drug to countless nursing home residents despite clear and irrefutable evidence that it could cause premature death in the elderly. Nursing home abuse lawyers at Pintas & Mullins highlight this case and how residents succumb to corrupt doctors.

According to investigative reports, Reinstein, who worked out of an office in the Uptown neighborhood of Chicago, gave clozapine to more than half of all his patients. Clozapine is a powerful antipsychotic drug, recommended for patients as a last resort. It can cause seizures, serious drops in white blood cells, heart wall inflammation, and death.

Reinstein received at least $350,000 in illegal payments from clozapine's manufacturer - a fact that came to light after a joint investigation by the Chicago Tribune and ProPublica, a non-profit advocacy group. After this investigation, the Illinois Department of Financial and Professional Regulation stepped in, beginning a two-year legal fight.

Reinstein has repeatedly denied any wrongdoing in his practice, and is seeking an to stop his license suspension in Cook County Circuit Court. He claims that every clozapine prescription was medically necessary, despite immense payments from the drugs' manufacturer, Teva Pharmaceuticals. Reinstein reportedly received $50,000 every year from Teva in a "consulting agreement."

In addition to this annual agreement, Reinstein also received numerous gifts from Teva, including free travel to and from Miami, fishing trips, lavish dinners, a boat cruise, and many tickets to sporting events. He enjoyed these gifts from 2003 to about 2009, when the investigation began, and Reinstein, undoubtedly feeling the heat, asked the drug maker to stop payments.

The legal battle is not looking promising for Reinstein. In March of this year, Teva agreed to pay a $27.6 million fine over claims that it paid Reinstein to prescribe the drugs. Another 2012 lawsuits against the disgraced doctor is currently pending in federal court regarding hundreds of thousands of false Medicare and Medicaid claims.

Nursing Home Deaths Tied to Clozapine


In addition to his Uptown clinic, Reinstein also served as a psychiatric medical director at over a dozen local nursing homes; one year he issued more prescriptions for clozapine than all doctors in Texas combined. It is impossible to understate how much damage he single-handed caused in the lives and wellbeing of his patients. At least three patients died of clozapine intoxication while under his care, and countless others lost their quality of life from this powerful antipsychotic drug.

One of his victims was a 50-year-old man named Alvin Essary, who was a resident at Somerset Place nursing home when he died in 1999. According to his medical records, he had over five times the toxic level of clozapine in his blood at the time of his death. Consequently, Essary's family sued Reinstein for his negligence, ultimately settling for about $85,000.

Another of Resinstein's patients was just 27 when she died of medication intoxication. According to investigations, Reinstein increased the dosage for Wendy Cureton at twice the recommended pace, and combined the drug with a sedative despite clear medical warnings not to do so. After yet another dosage increase, Cureton collapsed and died.

Continue reading "Illinois Revokes License of Nursing Home Psychiatrist " »

When and How to Choose Hospice Care

June 18, 2014

116482438_79d50d4e57_o.jpgAs Americans age, they are making greater use out of hospice care, which is offered to terminally ill patients at the end of their lives. Deciding to place yourself or a loved one into hospice care can be one of the most difficult of a person's life, and many are unaware that they have a choice of programs. Elder law attorneys at Pintas & Mullins offer some advice and a few tips on how to choose the right hospice.

Hospice programs involve comprehensive care for those near the end of their lives; the focus is on comfortable, at-home care, to relieve pain as much as possible. Although most hospice patients receive care in their homes, it is possible to receive hospice care while residing in a nursing home, even for those on Medicare.

Unfortunately, during the time most are considering a hospice program, they are in the midst of a health care crisis or have just received dire news. In other words, they are typically not in the best state of mind to research in-depth on the programs available to them. The good news is that hospice choices are growing, and now available in most communities throughout the country.

It is important to remember that, like nursing homes, hospices are sometimes run by large, for-profit corporations that may not always have the patients' best interests at heart. This is why doing research before choosing a facility is so important - not every hospice provides the same quality of care.

Advocacy groups like the American Hospice Foundation have been around for many years, collecting data on U.S. hospices during that time. Soon (within the next two to four years), it will release a tool to help consumers compare hospice programs using evaluations conducted by both primary caregivers and Medicare and Medicaid.

Knowing What to Ask


Before that becomes available, families need to do their own work, interviewing different hospice programs within their communities. During these interviews, caregivers often come to patient's homes and answer any questions they may have. How receptive they are to these questions and requests is the first indicator of how well a program is run.

Second, it is important to choose a program that has a solid foundation; avoid hospices that have only been around for a few months or even up to a year. The more established and stable a hospice is the better. You may be able to glean knowledge from friends, doctors or nurses who have heard about that program's reputation.

Third, ask about the staff's response times, whether they will be available in evenings and weekends, and how long the patient will need to wait in an urgent situation. Additionally, consumers should ask about the services the hospice provides. Although there is a set or standard services most are expected to give, the degrees and intensities of these vary.

For example, "continuous care," refers to the very last hours or days of someone's life, when 24/7 care is necessary. Ask the hospice if they will provide a caregiver at home during this time, if they will see the patient through to their death, and if the family will be supported. Another important service is inpatient facilities, in case complex health issues arise. Most hospices rent out units in hospitals or nursing homes to care for their patients who need additional services.

Continue reading "When and How to Choose Hospice Care" »

The Six Worst Nursing Home Facilities in California

March 26, 2014

There are about 1,300 long-term care nursing facilities in California, where over 300,000 residents are cared for. Unfortunately, most nursing homes are run by for-profit corporations, such as HCR ManorCare, which aim to make money by caring for our nation's elderly. Nursing home negligence attorneys at Pintas & Mullins highlight the six worst offenders in the nursing home industry in California.

4083404157_4715434f19.jpg The six companies outlined in this article were featured in by an elder law advocacy group in California, Stop Elder Abuse (Stop EA). This coalition specializes in identifying and exposing the companies with extensive records or harming or neglecting patients. All six nursing home chains are private corporations that knowingly place profits over patients, leaving elderly residents at risk of systemic abuse and neglect.
The six worst nursing home offenders in California are:

1. North American Healthcare (NAHC)
2. Longwood Management
3. Golden LivingCenters (previously Beverly Enterprises)
4. Sava SeniorCare
5. Emeritus
6. Vitas Innovative Hospice Care

Many of these companies operate on a national level, with hundreds of facilities. It is not difficult to see how this type of business model, when applied to compassionate care, can lead to widespread abuse. We will explore each corporation in detail below.

North American HealthCare

This company operates 35 facilities in four states, however none of them use the NAHC name. The U.S. Department of Health and Human Services (HHS) investigated NAHC in 2010 for suspected fraudulent billing, among other allegations. The feds found that 64% of NAHC patients were billed to the highest category of Medicare and Medicaid, which is reserved for only the sickest, most specialized patients (the national average is 9%).

There has also been much contention within the company over employee organization. Arguably, nursing home employees are the most important, critical part of how well residents are cared for. If staff is underappreciated and overworked, they simply will not have the time or resources to properly care for residents. This leads to significant problems in nursing homes, such as sepsis from untreated bedsores, the spread of infections, and overmedicating residents. It is unsurprising to learn, then, that NAHC has been subject to several civil suits over elder abuse and neglect, one of which resulted in a $29 million award to the victim's family.

Longwood Management

Longwood operates over 30 facilities in California, extracting money from each arbitrarily, to pay shareholders. This leaves its facilities unable to address critical patient needs, placing residents in immediate harm.

Golden LivingCenters

This corporation owns over 300 facilities throughout the country, with 20 in California. The company has been federally investigated for making false claims to Medicare and Medicaid and subjecting residents to substandard services that caused great harm. Former employees have said the company is run on fear and intimation, and that they had to beg for new wheelchairs and mattresses.

Golden was recently hit with a class action lawsuit for its failure to disclose the true nature of its business. Plaintiffs claim that Golden did not provide sufficient nursing staff, deceived and misled vulnerable elderly residents into becoming residents.

Sava SeniorCare

Sava ranks among the nation's largest nursing home chains, with 26 facilities in California. It has also been subject to extensive litigation over negligent and abusive resident care. Sava is known for hiring staff that is untrained, unqualified, unlicensed, and ill-equipped to handle the careful care of senior citizens.

Emeritus

Emeritus is the country's largest for-profit assisted living operator, with more than 500 facilities. It is a publically traded company, so the bottom line drives everything. Staffing is always kept to a bare minimum, training is nearly nonexistent, and health and safety codes rarely followed. Unsurprisingly, Emeritus is constantly in the midst of lawsuits from victims of abuse and neglect, but since they rake in about $1 billion in revenue each year, they can afford the litigation. PBS Frontline recently aired a special on their poor practices and million-dollar lawsuit payouts.

Vitas Innovative

Vitas is an end-of-life hospice company, which enjoys about $1 billion in revenue every year. The company was sued by the federal government in 2013 for - what else - improperly billing Medicare and Medicaid. Providing hospice care is an immense and incredibly important responsibility. Knowing that hospice companies are motivated by finances rather than compassionate care is disheartening to say the least.

Vitas encourages staff to admit as many patients as possible, regardless of medical status. The consequences of this practice are far-reaching, but most acutely felt by the elderly residents themselves, who so rarely get the help they need.

Continue reading "The Six Worst Nursing Home Facilities in California" »

The Elderly in the ER

March 18, 2014

6336510146_e76da8e697.jpgOur team of nursing home negligence lawyers recently wrote on the alarmingly high rate of elder injury from medical care (one third of nursing home residents are injured by medical errors). Unfortunately, nursing home residents are often admitted to the emergency rooms, where the staff knows next-to-nothing about the person they are taking care of. Here we have outlined a few ways those in the industry are trying to fix this.

Dr. Pauline Chen recently wrote a blog for the New York Times on the subject, asking whether emergency rooms are at all safe for the elderly. In her piece, Dr. Chen recounts the story of an elderly man she once treated in the ER for a serious infection. The man lived alone, was overwhelmed by the information given to him in the ER, and none of the staff had been trained in coordinating the complex care elderly patients often require.

Finally, unsure how to proceed, an older nurse suggested they just admit the man to the hospital. It would cost more, and was likely unnecessary, but it was the only way they could ensure he received proper care. This case is far from uncommon, and the number of older Americans who need immediate or complex health care is expected to increase substantially over the next few decades.

Because our healthcare system is already short of primary care and geriatric caregivers, many elderly people will wind up in the ER for things like infections or falls. Emergency rooms themselves, however, are usually overwhelmed by patients and doctors and nurses are required to get through patients as quickly as possible.

With elderly patients, particularly those with dementia or other cognitive conditions, working quickly is not only dangerous but nearly impossible. Many nursing home residents suffer from numerous physical and cognitive ailments, take several different types of drugs (which are difficult to remember), and have trouble remembering other important details.

Medical experts recognize this danger and are taking measures to improve it. Among their calls for action, these specialists assert that medical centers need to update their facilities to meet the needs of elderly patients. More specifically, they recommend that hospitals:

• Hire or train staff on caring for older patients
• Screen for dementia
• Install non-slip flooring
• Train staff on social factors elderly patients may require, such as transportation
• Have walkers, canes and other medical equipment on-hand
• Assistance with prescriptions

Is Telemedicine the Answer?

Others suggest that nursing homes start using telemedicine systems, which would let residents see a doctor through video conference. If a resident gets sick or injured, outside physicians can use video chat to see and speak to them. In a recent study on these types of systems in nursing homes, facilities that regularly used the service sent fewer residents to the hospital. That study, published in Health Affairs, can be found here.

However, simply making this type of service available in nursing homes does not guarantee that staff will properly use it. There is widespread issues inherent in the American nursing home industry, most poignantly how overworked the understaffed these facilities truly are.

Continue reading "The Elderly in the ER" »

One-in-Three Nursing Home Residents Injured During Treatment

March 4, 2014

senior-using-a-walker_l.jpgMedicare recently published a troubling study that found that one third of nursing home residents are injured during the course of their treatment through medical errors. Researchers also found that nearly 60% of these errors were preventable, and over half of injured residents had to be hospitalized. Nursing home abuse lawyers at Pintas & Mullins find these statistics disheartening, and offer analysis into the problem.

Among the medical errors described in the report include medication mistakes, new or spread infections, inadequate monitoring, and delay or failure to provide adequate care. Unfortunately, about 22% of patients suffered lasting harm from the errors, and 1.5% died even though they were expected to survive treatment.

The study centered on more than 650 patients who were treated in nursing homes about one month after being discharged from hospitals. About half of those patients had to be readmitted to the hospital after suffering substandard care in nursing homes, costing the healthcare system $208 million in just one month.

Most of the deaths resulted from excessive bleeding (from blood-thinning medications like Pradaxa, for which there is no mechanism to stop a bleed-out), kidney failure, fluid imbalances, and preventable blood clots. One patient specifically suffered a collapsed lung because nursing home staff failed to recognize the symptoms.

From their data researchers estimated that about 22,000 nursing home residents are injured each month from substandard nursing home care - and another 1,500 pass away. Federal researchers also noted that improvements are entirely possible, particularly calling on the Centers for Medicare and Medicaid Services (CMS) to aggressively promote patient safety in nursing homes.

What is Being Done to Fix It?

Similar strategies are already in place, however they focus almost exclusively on care in hospitals. CMS should also focus on instructing state inspectors to review and identify programs for reducing medical mistakes in nursing homes. State CMS agents inspect each nursing home that admits Medicare or Medicaid patients once a year (more so if the nursing home fails previous inspections).

Data from these inspections are made public, and ProPublica recently complied much of this information to create a Nursing Home Inspect database. All nursing homes in the U.S. are required to establish a Quality Assurance and Performance Improvement program.

It is important to note that the majority of medical errors in nursing homes are not caused by outright or malicious abuse or negligence. The majority of American nursing homes are run by for-profit companies, and, like any other private corporation, executives are primarily concerned with profits and pleasing investors. Unfortunately, this comes at a price, causing severely understaffed nursing homes.

Continue reading "One-in-Three Nursing Home Residents Injured During Treatment" »

California Nursing Home Fined after Resident Suicide

December 5, 2013

2296138797_d77a1198c9.jpgInadequate care in American nursing homes is a widespread problem, with often dire consequences. One recent case in California highlights the issue of suicide in long term care settings, which fortunately is not a common problem, though the statistics are not decreasing. Nursing home negligence lawyers at Pintas & Mullins bring this case to light to discuss the taboo subject of suicide among the elderly.

According to Geriatric Medicine and Medical Direction, the prevalence of depression in nursing homes is between 12% and 50%, depending on varying definitions. Many who actually work in the industry, however, tend to estimate the rates much higher, due to the nature of long term care facilities themselves. Residents are generally inactive, suffer from wide ranges of cognitive and physical ailments, lack personal autonomy, and are constantly confronted with sickness and death.

The case we would like to discuss, Del Rosa Villa v. Kathleen Sebelius, centers on a suicide that occurred in 2009. In May of that year, the resident jumped in front of a car in a suicide attempt and broke his leg. He was brought to a local hospital, where he was voluntarily committed to a psychiatric ward. Hospital physicians noted that he had intermittent thoughts of suicide, that his actions were unpredictable, and he posed a risk to himself if discharged.

A few weeks later, he was discharged to the Del Rosa Villa nursing facility where a nurse recommended he be placed on 24-hour suicide watch. Physicians noted he was experiencing hallucinations and delusions, writing that he be on suicide watch at all times. In June 2009, the resident was prescribed Ativan, a sedative that can actually increase the risk of suicidal thoughts.

In fact, according to Ativan's labels, "older adults may be more sensitive to side effects, and the elderly may not experience relief of anxiety, it may have the opposite effect." Despite these clear warnings, his dosage was increased several times. Then, during a late night in mid-June, after another dosage increase, the resident walked outside through the laundry room, telling the nursing staff he was going to have a cigarette. Just before 1 a.m., he was found hanging on the parking lot fence by his belt, and died soon after.

Medicare and Medicaid investigated and fined Del Rosa $10,000 for failing to supervise the high-risk resident. Del Rosa appealed, however the appeals court confirmed that it was reasonably foreseeable that the resident would harm himself if he was allowed to leave the facility unattended.

Advice for Families

Unfortunately, suicide rates are high among the elderly. If any dangerous thoughts are expressed or suspected, it is critical that nursing home staff create an emergency care plan for that resident and strictly adhere to that plan. This can include anything from 15-minute checks to more frequent physician sessions (physicians must always be informed of resident's depression assessments). If a care plan is explicitly established, and the nursing home staff fails to adequately follow it, any harm inflicted upon the resident can be grounds for a lawsuit.

The following are items that are most cited as reason for liability in suicide lawsuits against nursing homes:

1. The facility failed to adequately asses resident's mental health upon admission
2. Staff failed to advise the resident's physician of any changes in their mental health
3. Staff failed to monitor a resident prescribed to anti-depressants or psychotropic medications

Continue reading "California Nursing Home Fined after Resident Suicide " »

The Choice Between Hiring a Home-Care Aide and Placing your Loved one in a Nursing Home

November 21, 2013

Thumbnail image for helping-grandmother-walk_l.jpgAs the baby boomers age, more and more families have to face the difficult but necessary decision of how to care for their elderly loved ones. Home health care aides are the fastest growing occupation in the country, estimated to increase by 70% by 2020, according to data by the U.S. Department of Labor. Elder abuse lawyers at Pintas & Mullins understand how trying this time can be for the whole family, and offer a brief outline of the benefits and disadvantages of each side.

Personal care aides, often referred to as PCAs, receive no benefits or regular hours, and often make less than $10 an hour. So why is it the nation's fastest-growing occupation? The younger generation can see that the population is aging, and many of them, lacking in education or socioeconomic ability, recognize this as an opportunity. Additionally, Medicaid and other governmental agencies are asserting efforts to keep senior citizens out of nursing homes as much as possible.

Caregivers provide an array of services to allow the disabled and elderly to remain in their homes. This can include anything from daily chores and feeding to companionship and emotional comfort. They can either be self-employed, as independent contractors, or employed through a home-care company, such as HCR ManorCare. An estimated 90% of PCAs are women, and many earn so little that they have to rely on some type of government assistance, such as food stamps or social services.

Citing an article by Bloomberg, about half of PCAs in Vermont are paid by Medicaid, the federal program for the disabled and poor. The other half are paid via Medicare, private funds, or other health insurance programs. PCAs, whether independently contracted or employed through a healthcare agency, do pose their own risks to the elderly and disabled. Like any other service dependent on the goodwill of others, there is potential for significant abuse of power. When that abuse is against an elderly person, the results can be devastating.

In-Home Care vs. Skilled Nursing Facility

Nursing homes, such as the previously-mentioned HCR ManorCare, provide in-home assistance as well as chains of skilled nursing facilities. When large, for-profit corporations are responsible for thousands of nursing home residents in hundreds of different nursing homes throughout the country, the potential for wide-spread patient neglect is ominous. At nursing homes run by large chains, corporate executives are making the decisions for on-the-ground needs, which they are not attuned to or even, in most cases aware of.

Continue reading "The Choice Between Hiring a Home-Care Aide and Placing your Loved one in a Nursing Home" »

$48 Million Settlement in Nursing Home Fraud Whistleblower Case

November 20, 2013

Thumbnail image for 4083390539_c89107bf37.jpgMost nursing homes throughout the U.S. accept residents who use Medicare and Medicaid as their health insurance provider. These programs enable nursing home administrators to bill the federal government for therapy sessions, medications and other required health care services so they can be reimbursed. Unfortunately, this system is often abused by nursing homes lacking in funding or merely seeking an increase in profits.

A nursing home in Mission Viejo was recently busted for fraudulently billing Medicare for therapy sessions at its facility that either never took place or were medically unnecessary. The federal government takes these cases very seriously, and prosecuted the nursing home for its fraud, resulting in a $48 million settlement. The operator, Ensign Group, owns nursing homes along the West Coast and as far East as Iowa, as well as providing in-home care to seniors.

Between 1999 and 2011, Ensign systematically inflated the prices of its services when billing Medicare, even submitting claims for therapy sessions that were never provided. This occurred at at least six facilities, which billed for unnecessary speech, occupational, and physical therapy services, and even incentivized employees to increase the amount of sessions regardless of patient need. The six facilities are: Victoria Care Center in Ventura, Southland in Norwalk, Sea Cliff Healthcare Center in Huntington Beach, Orchard Post Acture Care in Whittier, Panorama Gardens in Panorama City, and Atlantic Memorial Healthcare Center in Long Beach.

What to do if You Suspect Fraud

This lawsuit was triggered by two whistleblowers, former employees of Ensign, who filed a complaint with the U.S. attorney's office about the fraud. Medicare and Medicaid payments to nursing homes are meant to provide residents with a safe and sanitary living environment, medical care, daily assistance, and nutritious meals. If a nursing home bills for any of these services but does not adequately provide them, fraud is being committed.

Under qui tam law, employees who suspect fraud are able to file claims with the federal government, which will then launch a thorough investigation. If there is indeed fraud being committed, a lawsuit will ensue and the whistleblowers are entitled to receive a portion of the verdict or settlement (often between 15 and 30%). It is not yet clear how much the Ensign employees will receive, although it will be anywhere between $7.2 and $14.4 million.

Fraud can be committed in a variety of situations, such as billing Medicare for a brand-name drug when really a generic is administered, or using cheap medical equipment while billing for more expensive devices. Certain signs can indicate fraud is being committed in a nursing home even if you do not know for sure. These signs include residents that are dehydrated or malnourished, unsanitary living conditions, broken-down medical equipment, and insufficient heat or air conditioning. It is important for nursing home employees and families of residents to know and be able to recognize signs of fraud, as it often leads to dangerous neglect and abuse of residents.

Continue reading "$48 Million Settlement in Nursing Home Fraud Whistleblower Case" »

No Mississippi Nursing Home without Violations Since 2010

October 21, 2013

4084164680_86390884b2.jpgNursing home negligence lawyers at Pintas & Mullins report that, of Mississippi's 205 nursing homes, not one has had a clean safety record in the past three years. Since 2010, nursing homes in that state have amassed over 4,500 violations from the U.S. Centers for Medicare and Medicaid Services.

It should be noted that these numbers reflect facilities that accept Medicare and Medicaid, however, not all nursing homes do. Facilities that are not certified to accept federal assistance programs are typically very small, private homes. Mississippi's long-term-care ombudsman, a post in the Department of Human Services, stated that the state's systemic failure is the result of low wages and inadequate training among nursing home personnel.

She further stated that many employees of Mississippi nursing homes make minimum wage, with no benefits, and could often make more at local casinos. Certified nursing assistants, for example, make an average of $24,600 a year in Mississippi, which is more than a fast food cook but less than a blackjack dealer at a casino.

Nursing homes that accept Medicare and Medicaid are subject to inspections at least once per year, along with unannounced inspections if there are any complaints filed. Facilities are also required to promptly report all incidents, no matter how seemingly trivial, to authorities. Certified nursing assistants must undergo and pass a 100-hour training course to be employed.

Overall, Mississippi nursing homes average about eight violations per nursing home. In the most recent Nursing Home Report Card, issued by the advocacy group Families for Better Care, the state earned a "D." Troublingly, perhaps due to the large volume of nursing homes around the Chicago area, Illinois received an "F" in the same report.

The systemic pattern of health and safety violations can have dire, often gruesome consequences for the state's elderly. In November 2010, an employee at Highland Home in Ridgeland, Mississippi found a resident hanging from her wheelchair's lap belt by the neck. The patient had low muscle tone and poor cognitive skills, and the belt's manufacturer specifically warned against its use in patients with these ailments.

The resident survived that incident, after which the facility switched her to a crotch restraint, despite manufacturer's recommendations that it be used only for patients with adequate posture. On New Year's Eve 2010, the same resident was found hanging from her wheelchair from the crotch restraint; the staff made no changes to her care plan and continued using the restraint, without regular monitoring.

At least three other residents at Highland Home suffered similar incidents, suggesting a pattern of inadequate monitoring and negligent care plans. Other serious problems noted at Highland are common among other nursing homes throughout the country: staff dropping residents while moving them, failing to follow physician's orders, unnecessary sedation, isolation and theft. Highland racked up $635,000 in 2011, the highest of any facility in Mississippi.

Continue reading "No Mississippi Nursing Home without Violations Since 2010" »

October is Nursing Home Residents' Rights Month

October 15, 2013

4084149130_31931048bb.jpgNursing home abuse lawyers at Pintas & Mullins announce that October is officially recognized as Residents' Rights Month. The rights of long-term care facility residents (including those in assisted living, retirement communities, and sub-acute units) are guaranteed by the 1987 federal Nursing Home Reform Act, which includes a Residents' Bill of Rights among its provisions.

In 1986, at the request of Congress, a study was conducted into the prevalence of abuse and neglect in nursing homes. The results of this study were abysmal, leading to sweeping changes in the industry and the Nursing Home Reform Act. The Act's basic objectives are to ensure high-quality, consistent care for our nation's elderly for their mental, emotional, physical, and psychosocial well-being.

Most care administered in nursing homes is paid for by the federal government though Medicare and Medicaid (58%), which means that most nursing home must accept these services to stay in business. The Nursing Home Reform Act requires facilities certified to accept Medicare and Medicaid to adhere with all aspects of the law, including the Bill of Rights, which can be found here.

This month provides elderly residents numerous opportunities to have their opinions and stories heard, through initiatives like the Resident's Voice Challenge, which encourages elders to consider and respond to four questions through writing or art of any type.

Elder abuse and neglect is becoming an increasingly public issue and recognized as an important problem, particularly due to the rapidly growing aging population. Experts predict that by 2025, the global population of people aged 60 and older will more than double, reaching about 1.2 billion. In the United States, though the threat of nursing home abuse and neglect is widely acknowledged, the prevalence of it remains in every state.

One survey found that over 35% of nursing home employees reported having witnessed at least one incident of elder abuse in the past year, and a staggering 40% stated that they themselves had psychologically abused residents. Elder abuse can take many forms, including physical, psychological, financial, and sexual; nursing home negligence, though not as malicious as abuse, can be just as devastating.

Even relatively minor acts of abuse or negligence, such as failing to regularly shift a bed-ridden patients' position, can cause serious, permanent, even fatal damage. Within institutions like nursing homes and assisted living facilities, there are several factors that make abuse and neglect more likely to occur. These may include overworked or understaffed employees, policies that reflect the interests of the institution (HCR Manorcare, for example) rather than individual patients, and cognitive disorder diagnoses.

Families of loved ones in nursing homes, especially those that demonstrate the above-mentioned characteristics, must keep an eye out for signs of abuse and neglect. Symptoms may include frequent visits to the ER, worsened chronic conditions (such as diabetes), differing stories between caregivers and residents, delays in medical attention for injury or illness, and implausible or extremely vague explanations for injuries or illnesses.

Advocacy groups like the Consumer Voice and AARP heavily emphasize the importance of speaking out because that is the only way abuse, neglect and mistreatment will be exposed and fixed. Their goal, which should be shared nationally, is to encourage residents to be educated about elder abuse and contact appropriate officials when suspicious incidents occur.

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Illinois Receives "F" in Nursing Home Report Card

September 18, 2013

4084143946_3f906a5f1c.jpgNursing home abuse lawyers at Pintas & Mullins regret to report that Illinois recently received a failing grade in reports by Families for Better Care, a nursing home resident advocacy group. Illinois is ranked 42nd out of all 50 states in quality of nursing home care. Alaska was named the best state for nursing home care, and Texas came in dead last.

The state-by-state report card was the first of its kind, analyzing eight categories of federal data to determine the quality of care in each state's nursing homes. Out of the eight categories, Illinois passed in only one category, verified ombudsman complaints, meaning complaints sent to the state's nursing home ombudsman were properly validated 73% of the time.

The other seven criteria for ranking were: percentage of state facilities with deficiencies, percentage of facilities with severe deficiencies, registered nursing hours, direct care staffing hours, health inspections above average, registered nursing staffing above average, and direct care staffing above average. Illinois fared the worst in percentage of facilities with deficiencies and severe deficiencies (96%, 27%) and direct care staffing hours (2.14).

Among its key findings in Illinois, the organization found that Illinois nursing homes in particular hired the least amount of frontline caregivers in the country, ranking last in direct resident care per day. About one in every four facilities in the state was cited with a severe deficiency, which was just one repercussion of failing to hire adequate professional nursing staff.

"Deficiencies" are defined as regulatory requirements that have not been met. They are then rated accorded to seriousness and scope (isolated, pattern, widespread), which then determines whether the problem is "severe" or not. Severe deficiencies in nursing homes typically include problems that jeopardize the immediate safety or health of residents or problems that can cause actual harm but do not place residents in immediate jeopardy. These can include failure to control infections, issues with pharmacy services and medication administration, or violations of resident rights.

The surveys Families for Better Care used to determine their rankings were conducted by the federal Centers for Medicare and Medicaid Services. These surveys asses nursing, medical, and rehabilitative care, activities and social participation, the physical environment, dietary and nutritional services, sanitation, and infection control.

Investigators also look into complaints made about a nursing home or its staff, which they determine either as substantiated (proven) or unsubstantiated. Complaints are grouped into general categories, such as related to dietary concerns, resident abuse or neglect, falsification of records, or unqualified personnel. Surveyors can cite additional deficiencies, serious or not, based on these findings.

In 2003, the federal Office of the Inspector General found that the percentage of nursing homes with deficiencies, the average number of deficiencies, and the total number of deficiencies significantly increased between 1998 and 2001. Much of this information can be found online, at the CMS Online Survey and Certification Reporting System (OSCAR).

This database includes the three most recent surveys for nursing homes certified for Medicare and/or Medicaid. Another online database that proves useful for families of loved ones in nursing homes is ProPublica, which recently developed a Nursing Home Inspect tool, allowing anyone to search and analyze details of recent nursing home inspections.

The Chicago Tribune recently reported on another dismal Illinois ranking: third among states in number of times federal officials suspended payments to nursing homes due to, again, serious deficiencies. This information was mined from the above-mentioned ProPublica database, which found that, since 2009, CMS payments were suspended 91 times from 78 different facilities.

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Over 1,200 Nursing Homes not Equipped with Automatic Sprinkler Systems

September 16, 2013

Nursing home abuse lawyers at Pintas & Mullins report that, despite federal mandates requiring them, more than 1,200 nursing homes throughout the U.S. do not have automatic sprinkler systems. This puts residents of those facilities in grave danger should a fire ever erupt.

munster-nursing-home-evacuation_l.jpg The law was published on March 13, 2008 and applies to all nursing home facilities accepting Medicare and Medicaid. The agency gave these facilities over five years to implement automatic sprinklers, which means they should have complied by August 13, 2013 at the latest.

The danger of noncompliance should go without saying: most residents of long-term care facilities have limited to no mobility, and would be unable to escape on their own in case of a fire. This danger is further compounded when nursing homes are understaffed, which most for-profit nursing homes are.

Understaffing nursing homes is a common practice among for-profit facilities because it increases the bottom line for the corporate owners, such as HCR Manor Care and Genesis HealthCare. In fact, one recent analysis found that for-profits maintain staffing levels about one-third lower than non-profits and government-owned nursing homes.

That analysis, led by researchers at the University of California San Francisco, examined the relationship between caregivers, staffing levels, and the quality of care at ten of the largest for-profit chains. They found that chains consistently keep labor costs low to increase profits at the expense of care quality. And, although top chains by and large have the residents that need the most care, total nursing hours were 30% lower than non-profits and government nursing homes.

Additionally, for-profits had 36% more deficiencies and 41% more serious deficiencies than the highest-ranked nursing homes. Among these deficiencies include failure to prevent infections, falls, mistreatment, bed sores, weight loss, dehydration, and poor sanitary conditions.

Complex electrical systems and kitchen or laundry operations in nursing homes pose significant hazards of fire, and many smaller nursing homes lack even basic fire safety standards. One of the most devastating fires took place in 1989, in Norfolk, Virginia, taking the lives of twelve residents and injuring nearly 100 more. The four-story nursing home housed over 160 residents, most of whom were bedridden. The fire started on the second floor, and no alarms were heard even as firefighters approached.

Bedridden residents were trapped in their rooms and had to be physically carried out by rescuers through heavy smoke and heat. Efforts to save those on the second floor took about 35 minutes. The blaze was thought to be the cause of accidental discarding of a lighted match onto a bed. The blaze was so deadly because there were no smoke detectors in patient rooms and interior fire alarms failed to operate, causing a significant delay in fire department notification. Resident removal was also difficult because many elderly patients were restrained in their beds with cotton ties or connected to life support systems.

A fire recently killed one resident at Meadowbrook Nursing Home in DeKalb, Georgia, and injured two others. The blaze set off two alarms, and firefighters were able to remove 75 out of 128 residents from danger. Like the 1989 blaze, the fire also erupted on the second floor of the facility; fortunately, Meadowbrook had an automatic sprinkler system, which doused the fire before firefighters even got there. The one resident who died was in the room the fire erupted in at the time. Due to the sprinkler system, the fire was contained to that room and no one else was killed.

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U.S. Files Suit against PharMerica for Dispensing Drugs to Seniors without Prescriptions

September 4, 2013

2392022758_dd4f85eca0.jpgNursing home abuse lawyers at Pintas & Mullins report that the United States federal government recently filed a lawsuit against pharmacy company PharMerica over allegations that it is dispensing medications to senior citizens without prescriptions. The company is also accused of submitting false claims to Medicare for these prescriptions.

PharMerica provides an array of drugs to long-term care facilities, such as nursing homes and assisted living facilities, including Schedule II controlled substances like oxycodone and antipsychotic drugs, which we have written extensively about on this blog. The federal government is arguing that PharMerica dispensed these dangerous, highly abused drugs to residents in non-emergency situations and without prescriptions.

This, of course, is highly illegal, as is billing Medicare and Medicaid for the improperly dispensed medications. Most residents of nursing homes in the country are dependent on Medicare and Medicaid for their health care costs. Whatever medications they are given, whether they ask for them or not, are billed to the government. PharMerica, allegedly, was taking advantage of the high costs of Schedule II drugs, and knowingly submitting the false claims for reimbursement.

The lawsuit was spurred by a July 2009 complaint by a PharMerica employee, who filed a suit against the company under the False Claims Act (FCA). By May 2010, two other employees had joined the suit and filed their own, similar complaints.

PharMerica serves about 300,000 long-term care residents for whom it fills approximately 40 million prescriptions per year. By allowing nursing home employees to order and administer narcotics and antipsychotics before a medical doctor deemed it necessary, PharMerica violated not only the FCA but the Controlled Substances Act as well.

Antipsychotics and narcotics have been used in long-term care settings for decades, often as chemical restraints, to subdue "unruly residents." With the introduction of such drugs after the Second World War, nursing home administrators decided to use pharmaceuticals to restrain residents prone to outbursts instead of physical restraints, such as straps and belts. This, despite the overwhelming lack of knowledge about how these drugs actually worked in the brain.

In recent years, the FDA has made notable efforts to deemphasize the use of narcotics and antipsychotics in nursing homes by adding black box warnings to these classes of drugs. Black box warnings are the agency's most powerful alerts, warning physicians that their use in certain demographics (say, in those with dementia) carries a very high risk of death.

It may surprise some to learn that scientists still do not understand the mechanisms through which most drugs (including antidepressants) work in the brain. There have been many theories, though they have all failed. There are more neurons in the human brain than there are stars in the Milky Way, and the more we try to treat it with pharmaceuticals, the more elusive it becomes. Physicians and drug companies continue to tell patients and families of nursing home residents, however, that their mental ailments are the result of 'chemical imbalances' in the brain, which gives them a reason to take their meds on schedule or, in the case of nursing homes, whenever they are irritable.

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Antipsychotic Drug Use on Decline in Nursing Homes

August 30, 2013

4083394575_f4bdac25d5.jpgNursing home abuse lawyers at Pintas & Mullins are glad to report the use of antipsychotic drug treatment in American nursing homes is on the decline. Antipsychotics, intended only for the treatment of such cognitive disorders as schizophrenia, have long been used in nursing homes as 'chemical restraints,' to subdue irritable residents, despite the severe and often fatal side effects.

The Center for Medicare and Medicaid Services (CMS) has been tracking antipsychotic use in nursing homes for several years, recently launching the National Partnership to Improve Dementia Care. Residents with dementia can become easily confused, agitated, or even violent if they are not cared for properly, and in nursing homes that are chronically understaffed, nurses may turn to antipsychotic drugs to subdue them.

Fortunately, between 2011 and 2013, the use of these medications fell more than 9% among long-stay nursing home residents, which translates to about 30,000 less seniors receiving unnecessary, dangerous medications. The use of antipsychotic drugs in patients who do not need them, such as those with dementia, can result in death, stroke, falls, and heart attack, among other side effects.

The Office of the Inspector General recently launched an investigation into the issue to see how often they are prescribed and the extent of their off-label use. The investigation focused on popular drugs Abilify, Seroquel, Zyprexa, and Risperdal. A similar report in 2011 found that an alarming 88% of dementia patients in nursing homes were prescribed an antipsychotic.

There are a number of alternatives for treating or dealing with dementia patients who are disruptive or cause disturbances, including enhanced nurse training, art therapy, exercise, and cognitive retraining. According to CMS, these alternative therapies promote dialogue, allow for creative expression, focus attention, elevate mood, engage residents, help trigger memories, give resident a voice, and build positive social interaction.

Families of residents in nursing homes can look out for signs of inappropriate or excessive antipsychotic use, such as poor self-care, anxiety, inattention to surroundings, nervousness or restlessness, unsociability, and wandering. Oftentimes residents are aware that the medications they are given are harming them, but are unable or discouraged from expressing their concern. When this happens, residents may become even more irritable, agitated, and uncooperative, reinforcing the dangerous cycle.

This type of situation recently occurred at a nursing home in South Dakota, leading to the abuse of a resident and subsequent arrest of the employee. The employee was charged with abuse of a disabled adult after the 76-year-old resident refused to take her medication. The employee proceeded to pull the resident's hair, used a knee to pin down her legs, and squeezed her chest to try to get her to take the medication. The employee threw water on the resident's face and allegedly yelled at her, saying she needed to take her pills.

In its initiative, CMS hopes to rethink the approach to dementia care, reconnect with residents via person-centered care practices, and restore good health and quality of life in American nursing homes. The states that prescribe the most amounts of antipsychotics include Louisiana, Tennessee, Texas, Utah, and Georgia.

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