South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Tom Price and violations of the STOCK Act

Posted in Advocacy, Medicare

Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising additional ethics concerns for President-elect Donald Trump’s nominee for Health and Human Services secretary.

Price bought between $1,001 to $15,000 worth of shares last March in Zimmer Biomet.  A few days later, the Georgia Republican congressman introduced the HIP Act, legislation that would have delayed until 2018 a Centers for Medicare and Medicaid Services (CMS) regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.  After Price offered his bill to provide Zimmer Biomet relief from the CMS regulation, the company’s political action committee donated heavily to the congressman’s reelection campaign.

Zimmer Biomet, one of the world’s leading manufacturers of knee and hip implants, was one of two companies that would have been hit the hardest by the new CMS regulation that directly impacts the payments for such procedures.

The new revelation is the latest example of Price trading stock in a healthcare firm at the same time as pursuing legislation that could impact a company’s share price. The Wall Street Journal reported that he traded roughly $300,000 in shares over the past four years in health companies while pursuing legislation that could impact them.

 Price sat on an influential Ways and Means subcommittee that directly oversees health care policy. “This new report makes clear that this isn’t just a couple of questionable trades, but rather a clear and troubling pattern of congressman Price trading stock and using his office to benefit the companies in which he is investing,” Chuck Schumer said in a statement. “The Office of Congressional Ethics needs to conduct an immediate and thorough investigation into these potential violations of the STOCK Act before Rep. Price’s nomination moves forward.”

His stock holdings have included Aetna Inc., Pfizer Inc, Amgen Inc., Bristol-Myers Squibb Co. and Eli Lilly & Co. In recent years he has sponsored or co-sponsored 44 bills with potentially important financial impact on the U.S. health care system, insurers and the pharmaceutical industry.

Rights & Protections Under the ACA

Posted in Advocacy

Here are a few consumer protections that Republicans will repeal:

Scorecard for Trump

Posted in Advocacy

The Lancet, a top global medical journal based in the United Kingdom, published a “scorecard” evaluating what his policies could mean for public health.  The scorecard evaluates Trump’s stated policies according to the 17 Sustainable Development Goals (SDGs). The 17 SDGs are a platform for improving human welfare around the world. They include basic principles like reducing poverty and hunger, improving education and gender equality, and protecting the global environment from pollution, waste, and climate change.  Red means that a policy represents a high risk to public health, amber a medium risk, and green a low risk.

Scorecard

Trumpcare is a Job Killer

Posted in Advocacy

When Obamacare became law, there was an incorrect assumption that it would be a job killer. In reality, jobs were created as a result of the Affordable Care Act helping lower the unemployment rate to 4.6% under Obama.

A Kaiser Family Foundation report found that Obamacare led 7% of employers with 50 or more full-time equivalent employees to bump part-time workers to full-time, whereas just 2% did the opposite.  Obamacare was not a job killer based on this report.

Trumpcare, though, could be a job killer. A new report from the Milken Institute School of Public Health at the George Washington University and the Commonwealth Fund estimate that the repeal of Obamacare could cost almost 3 million jobs by 2021. The lack of federal funding is expected to cut gross state product by $1.5 trillion between 2019 and 2023, meaning there will be less money to spend on hiring.

Only about a third of the nearly 3 million job losses are expected to be in the healthcare sector. The remainder will come from other industries as consumers are forced to spend more on their healthcare and have less disposable income to spend elsewhere (e.g., food, clothing, entertainment).

Without a firm plan to replace Obamacare, around 20 million people could lose their health insurance, and around 3 million people could also eventually lose their jobs.

 25 Million Set To Lose Insurance

Posted in Advocacy

Cassie Dagostino wrote an article on Rantt about Republicans’ attempts to replace ObamaCare without a replacement.  When the ACA became law in 2010, 16.3% of the population, or 49.9 million Americans, lacked health insurance.

Since the ACA’s enactment, the uninsured rate has been cut in half and the trend-line of record lows continues. In 2015, the percentage of people without health insurance coverage for the calendar year was 9.1 or 29.0 million, down by 1.3 percentage points (10.4 percent or 33.0 million) in 2014.

In Q1 of 2016, the uninsured rate hit a record low of 8.6 percent of Americans (persons of all ages uninsured at the time of interview), marking the first time it fell below 9 percent in the nation’s history, per the U.S. Department of Health and Human Services.

 

“Save our Health Care”

Posted in Advocacy

Slate had an interesting article about the millions of Americans in dozens of rallies protesting to keep ObamaCare.  “At each of the rallies, speakers talked about specific men and women whose health and/or finances were saved by the ACA in an effort to build up opposition to the Republican repeal efforts.”

Speaking on CNN, Sen. Rand Paul gave broad details about what could be in the Obamacare replacement package but pointedly did not say whether the almost half a million people in his state that have insurance under the current law would be able to keep it.

Why repeal ObamaCare without a replacement?

 

Covering Up Abuse and Neglect

Posted in Abuse and Neglect, Advocacy, Trial themes

The Chicago Tribune reported that two social workers, Kenneth Allen and Olufunmibi Ogunyipe, allege they were fired from Burnham Healthcare now known as Bria of River Oaks nursing home after refusing to fabricate medical records related to incidents of patient abuse.  Some of their patient-abuse allegations were investigated separately by the Illinois Department of Public Health, which cited the facility for safety violations, records show.

The nursing home has withstood years of state citations for violence, patient neglect and filth. Last year it received $16.5 million from Medicaid and Medicare while reporting $1.38 million in profits.  Records show that some of those federal health-care dollars went to Weinfeld’s uncle, nursing home magnate Morris Esformes, whose son and close business partner, Philip Esformes, is being held without bond in a Miami federal detention cell on charges that he orchestrated a $1 billion Medicaid kickback scheme in Florida.

Allen alleges that a supervisor told him to falsify the medical chart of a female resident who was hospitalized in 2012 with facial bruises and black eyes. Allen believes the woman was beaten by a fellow resident, but he was told to write that she had fallen. A state inspection report later found that the facility failed to properly investigate her family’s complaint that she was assaulted.

Allen alleges that after he documented a resident’s rape complaint, a supervisor ripped Allen’s report out of the medical file and tore it up. The state health department inspection concluded the facility had failed to thoroughly investigate the sexual assault allegation and to notify authorities.

Ogunyipe alleges that, in the case of a 60-year-old resident who had repeatedly requested a discharge, a supervisor told him in 2013 to write up medical notes falsely stating that Ogunyipe had tried repeatedly to transfer the man but couldn’t find a program with an open bed. A state health department inspection cited the facility for failing to assist the resident’s request for a discharge.

Ogunyipe alleges that a supervisor tried to deceive state inspectors by removing disheveled residents who might trigger state scrutiny because they appeared neglected. A supervisor gave him $30 to $50 to take the residents out of the building, buy them cigarettes, feed them at a McDonald’s and claim they were going on a field trip, saying: “They can’t be in the building,” the suit states.

Ogunyipe said that the administration wanted to conceal residents with untrimmed hair and soiled clothes because “you would know that they were not being cared for.”

He witnessed fellow employees entice residents back to their rooms with a cigarette or snack, then punish them. “They would just close the door and — boom, boom, boom! Deal with the resident. Beat him up. Spit on his face and then walk out, close the door,” Ogunyipe said.  (A 2012 state inspection report said two residents alleged guards beat or roughed them up in separate incidents. The report says that at least one guard at the home was fired as a result.)

“The scheme was characterized by unbridled greed”

Posted in Medicare, Trial themes

The Indianapolis Business Journal had an article about the fraud and greed that led to the indictment of nursing home owner and operator James Burkhart.   In an explosive federal indictment unsealed in October, kickback money was used to buy gold bullion, casino chips, and vacation homes in a massive fraud scheme.  The fraud and kickbacks combined totaled more than $16 million, with the proceeds going to fund the men’s lavish lifestyles.

The indictment states that Burkhart, former CEO of Indiana’s largest nursing home company, and three other men orchestrated a scheme that used kickbacks and shell companies to defraud American Senior Communities which is owned by the Jackson family of Indianapolis; Health & Hospital Corporation of Marion County, which hired ASC to operate its nearly 70 nursing homes; and federal health care programs.
The defendants are former CEO James Burkhart, former Chief Operating Officer Dan Benson, Joshua Burkhart and Steve Ganote.  A 35-page indictment alleges that the four launched the brazen scheme to enrich themselves in 2009 and continued it until Sept. 15, 2015, the day FBI agents raided the nursing home company’s offices.

“The scheme was characterized by unbridled greed,” U.S. Attorney Josh Minkler said.

Resident Tased by Police

Posted in Abuse and Neglect, Dementia Care

WCCB Charlotte reported the tragic assault of a resident suffering from dementia by police with tasers.  When the incident happened in March, the sheriff made excuses defending the police by claiming the resident assaulted another resident and was resisting officers when they tried to get him to a doctor’s appointment.  The police body cam video shows the man waving his hands near the officers. When he attempted to walk away, the deputy tased him.  The family says the man died two months after the tasing, and believes his death is connected with what happened.  See more info at WWLP.

Dumping for Profit

Posted in Abuse and Neglect, Advocacy, Medicare, Trial themes

Herald Mail Media reported on the accusation of resident dumping by the owner/operator of five Maryland nursing homes.  The suit alleges that during a 17-month period between Jan. 1, 2015, and May 31,  Neiswanger Management Services LLC issued involuntary discharge notices to at least 1,061 residents at the five facilities it operates.

NMS and a number of its officers were named in a civil suit and charged by the state Office of the Attorney General with dumping “frail and disabled” Medicare and Medicaid residents in sham assisted-living facilities and homeless shelters, and submitting false claims to the state.

A number of dumping incidents are listed in the 62-page complaint including a woman with cancer who was driven to an unlicensed care facility in Baltimore and a woman who was left in the driveway of a relative’s home on a 95-degree day, the document said.
 “In at least 1,038 of these cases, the reason for discharge cited by NMS was the resident’s failure to pay for his or her care, or to arrange for payment by Medicare, Medicaid or another third party payor,” the suit states. By contrast, the suit noted, Maryland’s other 225 nursing homes issued about 510 such notices during that period.
NMS facilities received more than $100 million in Medicare and Medicaid reimbursements in 2015, $35 million of that from the Maryland Medical Assistance program, the suit states.

NMS preferred Medicare patients for admission because of the higher rates of reimbursement, then “aggressively seeks to evict Medicare participants as close as possible to their last covered day” without regard to their medical needs, the suit alleges.

An email from owner and former chief executive officer Matthew Neiswanger is quoted in the suit. In the email, he states, “Total of 22 empty beds! … Fill beds with Medicaid if you can’t get Medicare!!!”