Coluccio Law

$38 Million Settlement for Nursing Home’s Medicare Fraud

Washington will receive about $1 million in reimbursement for Medicaid and Medicare charges billed by Extendicare.

The nursing facility company is paying out $38 million to eight states and the federal government. A Department of Justice investigation found that Extendicare billed for care that didn’t meet Medicare standards—or in some cases, didn’t happen at all—including:

–       Procedures to prevent pressure ulcers, and prevent falls

–       Improper staffing, providing too few skilled nurses

–       Failure to provide proper catheter care

When a nursing home bills Medicare for patient services, the facility has to meet basic standards of care.

Extendicare currently operates 146 nursing facilities in 11 states (15 are in Washington). Of those, 33 nursing homes billed for patient care that did not meet federal and state standards.

The Extendicare investigation, prompted by two whistleblowers in separate nursing facilities, found that Extendicare billed Medicare and Medicaid for services that “were so deficient that they were effectively worthless…”

Extendicare also billed for unnecessary rehabilitation services, timed with the goal of charging Medicare as much as possible.

“Health care providers must make decisions regarding the level of services to be provided based solely on their patients’ clinical needs, and not corporate financial targets.”

– Acting Assistant U.S. Attorney General Joyce R. Branda

According to the Seattle PI’s Boomer Consumer investigator, $595,000 of Washington’s reimbursement will go to the federal government for its share of Washington’s Medicaid program.

Medicare fraud is a serious crime: reporting is crucial for holding nursing homes and other medical facilities accountable.

Caretaker stole $250,000 from elderly patient

A judge sentenced the caregiver for an elderly Oregon woman to three and a half years in prison.

Ana Hagan is believed to have stolen about $250,000 from the elderly woman in her care. The police found evidence that she had lost $233,000 gambling at a casino.

Last week, she pleaded guilty to criminal mistreatment and theft charges.

Busted by the bank

Financial abuse of the elderly is a big but quiet problem: it’s the most common form of elder abuse, but often goes unreported.

In this case, the elderly woman’s bank, Central Willamette Community Credit Union, prompted a police investigation when they flagged suspicious account activity.

The intrepid credit union employees who contacted the police deserve our thanks.

Bank monitoring is one of the best tools we have to stop the financial exploitation of senior citizens. See Shame, Embarrassment and Privacy Laws Shouldn’t Allow Financial Elder Abuse.

What’s wrong with Illinois’ plan to prevent nursing home abuse

A new law proposed in Illinois would permit the use of cameras in nursing homes to monitor patient care.

The use of the cameras would be voluntary, although there are questions about obtaining consent from elderly residents, their visitors, and the nursing home staff.

Nursing home safety (if you can afford it)

Patients and their families would have to purchase and set up the equipment themselves, and then monitor the footage.

In this plan, a patient’s safety is contingent upon their ability to finance and install an expensive surveillance system. Many senior citizens in long-term care facilities (which are hugely expensive) can’t afford that.

Additionally, this plan assumes that there are family members who are willing and able to watch hours of video footage on a regular basis.

Who’s in charge here?

Families should be allowed to monitor the care of elderly relatives. “Granny cams” have recorded elder abuse in other cases.

And there’s a good argument that the mere presence of a camera would decrease the risk of nursing home abuse: surveillance in itself changes behavior.

But should the State of Illinois place the burden of ensuring nursing home safety on the patients themselves?

Nursing home abuse and neglect is a big problem. Illinois received a failing grade in a national study released in May 2014. Voluntary surveillance captured and monitored by those who can afford it may help, but overall, this plan does not come close to solving the problem.

How do I know if a nursing home is safe?

There is no way to be 100% certain that your elderly relative won’t suffer an injury or trauma in a nursing home.

But when it comes to elder care, knowledge is power. If a home has history of abuse or neglect complaints, it’s a sign of serious, systemic problems.

Search for nursing home complaints 

Medicare tracks nursing home violations and deficiencies. Nursing Home Inspect has organized that data: you can search for a specific facility – for example, “Harborview Hospice”; or by location – “Aberdeen, Washington”. The information is updated monthly, and covers the past three years.     

  • How many complaints – or “deficiencies” have residents filed?

For example, Kittitas Valley Health & Rehab Center in Ellensburg, Washington has a shocking 59 verified complaints.

  • How severe are the violations?

Severity ratings range from “A” violations—the least severe, usually the potential for harm, without actual damage— to “L” violations, the most severe incidents, occurring in a pattern.

  • What actually happened?

Medicare’s incident reports are included; you can see the details of specific incidents, and know what to watch for if you have a relative in that facility.

Coluccio_Law_Nursing_Home_Checker

A search for “Seattle, Washington” found 216 elder care facilities, with a total of 913 deficiencies.

 

This is a great resource, but one of the best things you can do to ensure a safe, healthy nursing home experience is to go there often, and on various dates and times.

If the residents generally seem happy and healthy, it’s a good sign.

If you suspect something is wrong, you’re probably right. Request an investigation.

See: How to file a Nursing Home Complaint: 4 easy steps. 

 

How to file complaint against a nursing home: 4 easy steps

Too often, people wait until an elderly person is seriously or fatally injured before registering a nursing home complaint.

If you even suspect that nursing home residents are being neglected, abused, or been treated improperly, you can—and should—file an official complaint to alert state authorities to investigate.

4 steps to filing a complaint:

1. Write it down. Get the facts down on paper as quickly as you can: it’s much easier than trying to remember the details later.

2. Fill out the investigation form. Medicare has contact info for every state agency charged with investigating malpractice, abuse and neglect complaints. You can remain anonymous in the report, but give them as much information as you can, including:

  • Date and time of the incident;
  • Address of the facility, and location within it (cafeteria, hallway, etc.);
  • Your description of what happened (this is where your notes come in handy).

3. Send it in. Mail, email, fax, or even call, but file the form as soon as possible. The sooner you file, the sooner the problem can be addressed.

4. Follow up. A representative should contact you; ask to be notified when the final report is complete.

You don’t have to wait for an incident or an injury.

File a complaint if you know about unsanitary or unsafe conditions, or chronic understaffing in an elder care facility.

According to the Washington State Department of Health, our state investigates all claims involving:

  • Patient abuse or neglect
  • Staff not available to provide care
  • Failure to provide care
  • Providing the wrong care
  • Medication errors or mistakes
  • Unsafe, unclean or dangerous areas in the facility
  • Patient injuries or falls
  • Not following medical orders
  • Improperly prepared food
  • Not responding to a patient complaint

Click here to file a nursing home complaint in Washington

If you need help with this process, contact Coluccio Law for a free consultation.

LGBT elderly face higher risk of abuse and neglect

Many elderly people who identify as gay, lesbian, bisexual or transgendered are more likely to be abused or neglected.

For generations of LGBT who lived through decades of discrimination, this is the final indignity.

Research compiled by the National Center on Elder Abuse foundhttp://www.ncea.aoa.gov/images/Logos/ncea_logo.gif:

  • 29% of the LGBT elders surveyed had actually been physically attacked;
  • 65% reported verbal abuse, threats of violence, sexual assault, and discrimination, and other victimization; and
  • 8% had been abused or neglected by homophobic caretakers.
  • LGBT are more likely than heterosexual elders to live alone – and social isolation is a big risk factor for abuse; and
  • They are also less likely to seek help for abuse.

The data is comparatively limited, and compiled from the few peer-reviewed studies on the elderly LGBT community (which also speaks to the problem of discrimination).

However, it’s clear that more effort needs to be made to address and prevent elder abuse in the LGBT community.

Many LGBT elders lived with stigmatization for much of their lives—we owe them dignity and protection in their golden years.

Big jury verdicts against nursing homes are more important than you think – here’s why

Mr. Sharon had eleven different infections. His arms and legs had been in traction so long that he is now paralyzed. He was frequently soiled, and his wounds went untreated.

According to the attorneys who represented the nursing home patient and his family,

“ … Repeated instances of abuse and neglect at the nursing home led to the development of bedsores so severe and deep that at least one was infected down to his bone.

Abuse like this can’t be attributed to one bad nurse. Injuries like these can’t be blamed on overworked aides.

These are problems that start at the top. There are systemic failures in any medical facility in which these injuries could happen.

Mr. Sharon was a patient in a for-profit Colorado nursing home. For-profit chains of nursing homes use fewer resources on patient care: they have fewer nurses, higher costs, and more profits.

How do you punish a corporation?

The jury that heard this case had to decide.

You can’t send it to prison. The only things you can take away from it are it’s reputation, which is hard to quantify— or money.

In Mr. Sharon’s case, the jury awarded 3.3 million dollars.

Sound like a lot of money?

There’s actually a limit of $300,000 for non-economic damages under Colorado law. The jury thought that amount would barely put a dent in the company’s bottom line – so they included $3 million in punitive damages.

This was the jury’s way of sending a message to the nursing home—Belmont Lodge Health Care Center and its parent corporation— and to other for-profit facilities.

A trial by jury is one of the most democratic tenants in our imperfect justice system.

It is utterly essential that everyone have access to courts and lawyers exactly for situations like this. Elder care facilities that victimize or neglect the patients who depend on them for care must be held accountable.

Jury verdicts like this one are they only way they’ll get the message.

 

Everybody counts: one big problem in death claims involving the elderly

Imagine that you’re driving home from work. Coming up to a red light, you see an elderly man step off the curb at the intersection. The car next to you doesn’t see him, and turns right – directly into him.

You, being a good citizen, call 9-1-1.

The operator tells you that all of the ambulances are busy with more valuable people. You call the police: they won’t come because a young person got in an accident down the street, and well, it’s more important that they tend to him. You take the elderly man to the hospital yourself, but the ER doctor won’t see him, since he’s going to die soon anyhow.

Sounds crazy, right?

A little legal background:

When an elderly person dies as a result of nursing home neglect, their family can file a lawsuit. This is called a “wrongful death” claim.

What most families aren’t prepared for: the claims adjusters and defense attorneys arguing that the death of their parent, grandparent or sibling has little value, since they were going to die soon anyhow.

My response to this is always the same: either everybody counts or nobody counts.

Outside of litigation, no one rates the value of people’s lives by age.

Here, we are talking about the death of an elderly loved one. Someone that we understood had only a short time to live. Someone that we understood was not going to be with us for that much longer.

Regardless of the short time that our loved one may have had with us, when they are wrongfully taken from us, there must be an appropriate accounting for the injury, abuse or neglect that took them too soon.

The life was shortened, regardless of how much or little it may have been shortened.

It may have been just a few more holidays with the family, just one more wedding, just a birthday party. Those of us who have lost a close relative would give a lot for one more day.

We can’t allow lawyers for negligent nursing homes to diminish the value of our memories and experiences with our loved ones.

 

This post was adapted from nursing home abuse attorney Kevin Coluccio’s article Everybody counts: Death of our older clients, originally published in Trial News, February 2014, for the Washington State Association for Justice trial lawyers.

About Kevin

Kevin Coluccio was recently named one of the Top 10 Super Lawyers in Washington State. He has long history of successful elder abuse/neglect cases and has a stellar reputation for getting results for his injury clients in serious car crashes, pedestrian accidents, trucking accidents, maritime claims, and asbestos injury cases.