Medicare

80% of Nursing Homes Lying About Staffing Levels

There is no question: the quality of resident care in a nursing home care is directly connected to staffing levels. Low staffing levels are consistently linked to a higher likelihood of elderly patient injury and death.

When nursing home companies report inaccurate staffing data, they are basically lying about resident safety.

A new data review on 10,000 nursing homes showed that the staffing levels they provided to Medicare—and listed on the Nursing Home Compare website—doesn’t match their financial reports.

A Center for Public Integrity just completed an analysis of nursing homes’ annual financial cost reports. The analysis found that up to 80% nursing homes are inflating their staffing levels.

About 25% reported twice as many staff hours as their payroll data actually shows.

Medicare’s rating should be based on real data

Medicare has a 1 – 5 star rating system for nursing homes. That data is made public so that families can make informed choices for elder care.

Currently, a facility’s rating is at least partially based on its self-reported staffing hours.

The rating system is supposed to be updated under a provision of the Affordable Care Act. Nursing homes will have to submit real payroll data for nurses, instead of just reporting their staffing hours. But it hasn’t happened yet — and it may take up to two more years.

In the meantime, assume that the 5-star rating system used on Nursing Home Compare data is flawed. So how do you know if a nursing home is safe?

$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.

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.

President Obama Signs Bipartisan Medicare Law

Just a few days ago, President Obama signed H.R. 1845 (112th), the bipartisan Strengthening Medicare and Repaying Taxpayers (SMART) Act, which was introduced by Reps. Tim Murphy (R-PA) and Ron Kind (D-WI) in the House and Sens. Ron Wyden (D-OR), Rob Portman (R-OH), Ben Nelson (D-NE) and Richard Burr (R-NC) in the Senate.

The legislation was a bipartisan solution to streamline the Medicare Secondary Payer (MSP) system, to ensure that seniors and persons with disabilities get timely assistance and taxpayers are repaid millions of dollars every year.

The SMART Act is seen as a victory for senior advocates.

We will see how effective SMART is, as the Centers for Medicare and Medicaid Services (CMS) must still work to eliminate confusion and uncertainty by providing clear, efficient and definitive information to seniors.

Medicare Secondary Payer (MSP):

– The MSP process ensures Medicare is reimbursed for medical bills that are the responsibility of another party – such as an insurer or negligent party.

– A senior or person with disabilities who has been injured, and later obtains recourse through the legal system, often cannot access their settlement until Medicare is reimbursed for all medical cost

– The current MSP system is inefficient and slow to return dollars to the Medicare Trust Fund, which is funded by tax payer money

– It can take years for the Centers for Medicare and Medicaid Services (CMS) to report reimbursement amounts to beneficiaries and CMS can seek multiple reimbursement amounts over time, providing further delay and uncertainty

The SMART Act will:

  • Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.

CMS must upload care payments they disperse within 15 days with the required information about the payment.

  • Streamline the process of obtaining reimbursement amounts.
  • Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
  • CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed
  • Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.
  • Provide a process and timeline for discrepancies and appeals.

Medicare beneficiaries can provide documentation for discrepancies on the web portal to CMS. CMS has 11 days to respond to discrepancies.

– If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.

– An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.

– Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.

– Readjust the penalty for reporting errors by insurers based on the violation.

– Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers.

– Create a three year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.

Washington State Watchdog Program Gets Huge Budget Cut

According to a recent article in The Columbian, a Washington State watchdog program that addresses complaints regarding elder abuse neglect and abuse will soon lose about a third of its funding. This is because of a decision by the Centers for Medicare & Medicaid Services to stop reimbursing the state Long Term Care Ombudsman ProgramWA LongTerm Care Ombudsman Program.jpg.

The state long-term care ombudsman explained that this large budget cut will result in a loss of staff, which will translate to slower response times to complaints about nursing home abuse and nursing home neglect.

At present, there are about 2,700 long term care facilities around the state with about 400 volunteers who advocate for the residents. These volunteers also communicate about issues raised by residents regarding resident rights. Complaints about about abuse or neglect at a long-term facilities are ofte4n reported by the volunteers.

However, due to budget cuts, training program required for volunteers will be accessible with fewer locations and staff.

According to Terry Cumpton, special assistant in the agency’s Seattle office, Washington is the third state in the country that the Centers for Medicare & Medicaid Services has pulled Medicaid expenses for ombudsman programs.

 

Medicare Site a Wealth of Knowledge for Elder Care

Medicare’s website provides an excellent resource for those making the tough decision of whether and where to place a loved one in a nursing home. The Official U.S. Government Site for People with Medicare, www.medicare.gov provides useful and detailed information. If you are struggling with the decision, the site provides alternatives to a nursing home for you and your family to consider.

Other useful information on the site includes:

  • A nursing home rating system;
  • An easy way to find medical equipment suppliers;
  • A comparative tool for nursing homes;
  • Medical nutrition therapy; and
  • Caregiver stories.

If selecting a nursing home is, indeed, the option you have chosen, follow the steps set forth on the website and take both the time and care to consider where you will being placing your loved one. This is an important decision, so take great care in obtaining as much information as possible. Look at ratings, heath inspection results, staff data, and quality measures.

Once you have narrowed your list of homes to a few, take the time to visit the homes, wander the hallways and to observe the nature of the care and the appearance of the residents. If possible, talk to families who have their loved ones at the home. Visit a few times, as each visit may provide you with new information. Some of the less reputable homes put on a facade for a sales visit.

Only by coming in armed with information and taking the time to conduct a thorough investigation on your own can you break down that wall and see if the home is right for your loved one.

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.