South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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Falsifying Records and Fraud

Posted in Medicare, Regulatory enforcement, Trial themes
CYNCentral and WKTV reported that Mohawk Valley Nursing Home LLC pled guilty to falsifying business records and has agreed to pay $1 million in overpayments to the Medicaid program.  This resolves a case that involved a 45-count indictment that alleged patient abuse and neglect and charges of falsifying records to cover up the incidents at the… Continue Reading

Genesis Settles False Claims Act allegations

Posted in Abuse and Neglect, Advocacy, Medicare, Trial themes
McKnights’ reported that Genesis Healthcare LLC will pay $600,000 to resolve False Claims Act allegations for a skilled nursing facility in Arlington, VA. In addition to the settlement, the nursing home chain will pay for a transition consultant to assist the new operator of the skilled nursing facility for a year. This consultant will help “identify… Continue Reading

PharMerica Settles with South Carolina

Posted in Medicare, Medications, Trial themes
The Post and Courier reported the settlement involving South Carolina and PharMerica to settle allegations of health care fraud.  The federal government contends it illegally promoted the use of Aranesp, a drug used to treat anemia that is manufactured by the pharmaceutical company Amgen. PharMerica has agreed to pay the federal government $2.5 million. PharMerica is a… Continue Reading

“That is wrong on so many levels”

Posted in Advocacy, Medicare, Trial themes
The Times Herald-Record’s recordonline.com reported that Elant Inc.’s civil settlement with NY will not protect them from criminal prosecution for Medicare and Medicaid fraud.  The settlement, however, makes clear that it is civil in nature and does not preclude criminal action or civil suits by individual patients or insurers.  The $600,000 settlement between the state attorney general… Continue Reading

Health Care Fraud

Posted in Advocacy, Medicare, Trial themes
Dr. Robert Hadley Gross, a Texas psychiatrist, has been sentenced to less than six years in federal prison for submitting false claims for services at a nursing home that were never provided.  Gross was also fined $100,000 and must pay $1.8 million in restitution. Gross was found guilty in September of one count of healthcare… Continue Reading

Hospital-Acquired Conditions Reduction Program

Posted in Advocacy, Medicare, Trial themes
Hospital-acquired conditions are a major factor in patient safety. According to the Partnership for Patients, in 2010 adult patients experienced about 4.8 million HACs in 32.8 million hospitalizations. The Agency for Healthcare Research and Quality estimates that the additional cost of HACs ranges from $1,000 for treating a catheter-associated UTI to $17,000 for treating central-line… Continue Reading

Elant Settles Fraud Allegations

Posted in Advocacy, Medicare, Trial themes
LOHud had an article on Elant Inc. settlement with NY.  Elant agreed to pay $600,000 after senior managers admitted directing administrators to delay the release of short-term residents to bilk Medicare and Medicaid out of hundreds of thousands of dollars, according to authorities.  Elant admitted that it postponed the release of short-term residents who were clinically ready… Continue Reading

Sava’s Medicare Fraud

Posted in Advocacy, Medicare, Nursing home cases in the news, Trial themes
McKnight’s reported that the federal government has thrown its weight behind whistleblower complaints against skilled nursing chain SavaSeniorCare LLC.  Authorities joined three lawsuits accusing the massive provider of “routinely” billing for therapy services that were either unnecessary or not medically reasonable.  Prosecutors consolidated the complaints, alleging that SavaSeniorCare “exerted significant pressure” on its skilled nursing facilities… Continue Reading

MedPac to Freeze Medicare Reimbursement Rates

Posted in Medicare, Trial themes
McKnight’s reported that the Medicare Payment Advisory Committee recommended Congress freeze market-basket updates for facilities for fiscal years 2017 and 2018. MedPAC pushed for the payment rate freeze, because the level of Medicare payments to SNFs “remains too high.” The group’s draft also recommends that the SNF prospective payment system be revised, due to differences in… Continue Reading

$25 Million on Psychological Tests!

Posted in Advocacy, Medicare, Trial themes
McKnight’s had an article on two psychologists charged for billing Medicare $25 million for psychological tests on nursing home residents that were either unnecessary or never provided.  Beverly Stubblefield, Ph.D., and John Teal, Ph.D., owned two psychological services companies that contracted to nursing homes in Louisiana, Mississippi, Alabama and Florida. Stubblefield and Teal, along with… Continue Reading

False Claims Act Lawsuits against SavaSeniorCare

Posted in Medicare, Trial themes
Department of Justice Office of Public Affairs FOR IMMEDIATE RELEASE Thursday, October 29, 2015 Government Intervenes in Lawsuits Alleging That Skilled Nursing Chain SavaSeniorCare Provided Medically Unnecessary Therapy The government has intervened in three False Claims Act lawsuits and filed a consolidated complaint against SavaSeniorCare LLC and related entities (Sava) alleging that Sava knowingly and routinely… Continue Reading

“Optimizing Revenue”

Posted in Advocacy, Medicare, Trial themes
The New York Times had an interesting article regarding a new report by the inspector general of the Department of Health and Human Services.  The report states that nursing homes are exploiting the billing system for therapy.  Nursing homes receive far more in Medicare payments than it costs them to provide care, and by giving patients more therapy… Continue Reading

“Maximize Reimbursement”

Posted in Medicare, Trial themes
LJWorld reported a story on the heroic whistleblower Megen Duffy.  She was an emergency room nurse at Lawrence Memorial Hospital that witnessed the falsification of records to increase reimbursement payments from Medicare and Medicaid.  Duffy worked at LMH from August 2009 to October 2013 as an emergency department nurse.  The suit alleges that arrival times of patients… Continue Reading

Therapy Generates Profit

Posted in Advocacy, Medicare, Trial themes
The Wall Street Journal had an article on how profitable therapy is for nursing homes and how they exploit the regulations to make the most money.  Medicare pays nursing homes a daily rate for a person’s stay based largely on the duration of therapy.  Medicare pays for up to 100 days of nursing-home care following hospitalization;… Continue Reading

Medicare’s Impressive Hat Trick

Posted in Advocacy, Medicare
USA Today had an interesting article on Medicare improvements in reducing deaths, hospitalizations and costs, a new study in the Journal of the American Medical Association (JAMA) shows.  Mortality rates among Medicare patients fell 16% from 1999 to 2013. That’s equal to more than 300,000 fewer deaths a year in 2013 than in 1999.  Among fee-for-service… Continue Reading

Happy 50th Birthday to Medicare and Medicaid!

Posted in Advocacy, Medicare
ThinkProgress had an interesting article on the 50th anniversary of Medicaid and Medicare.  President Lyndon B. Johnson signed Medicaid and Medicare into law 50 years ago today. Simply, Medicaid provides health insurance for poor Americans, and Medicare provides insurance for Americans over 65 years old. In 1966 a large portion of seniors were uninsured. Today,… Continue Reading

Medicaid Expansion Would Save Lives and Money

Posted in Advocacy, Medicare, senior care, Tort Reform
As part of the Affordable Care Act’s provisions, expansion of Medicaid benefits has become available to all state governments that accepted the deal in 2014. Many states, however, are declining to participate in the expansion, despite the fact that it would be allocating tax dollars, already given to the federal government by the states, back… Continue Reading

Largest Kickback Scheme

Posted in Advocacy, Medicare, Trial themes
A Miami home health company has agreed to pay $17 million for paying doctors to refer Medicare patients.  Department of Justice officials said that the settlement with Hebrew Homes Health Network Inc. is the largest involving violations of the Anti-Kickback Statute by skilled nursing facilities in the United States. Prosecutors said Hebrew Homes hired numerous… Continue Reading

Largest Medicare Fraud Bust

Posted in Advocacy, Medicare, Trial themes
WGNO reported that the FBI arrested 46 doctors and nurses across the country last month in the largest Medicare fraud bust ever; 243 people were arrested in 17 cities for allegedly billing Medicare for $712 million worth of patient care that was never given or unnecessary.  Four people are charged for mass-marketing a talking glucose monitor and… Continue Reading

Waste, Fraud, and Abuse

Posted in Advocacy, Medicare, Trial themes
The New Yorker had an incredible article written by Dr. Atul Gawande about waste, fraud, and abuse in the health care industry.  This is a fantastic article written by a general surgeon talking about what really drives up medical care – low value and unnecessary care.  Surprisingly, he doesn’t blame “frivolous lawsuits” as many doctors reflexively… Continue Reading

Success of Pioneer Accountable Care Organizations

Posted in Advocacy, Medicare, Trial themes
The American health-care system by and large runs on what experts describe as a “fee-for-service” system. For every service a doctor provides — whether that’s a primary care physician conducting an annual physical or an orthopedic surgeon replacing a knee — the doctor typically gets a lump sum of money. American doctors aren’t paid on… Continue Reading

Recidivist Doctors

Posted in Medicare, Regulatory enforcement, senior care, Tort Reform, Trial themes
Nursing homes with visiting physicians or providers should uncover their troubled histories with Medicaid or Medicare programs in other states or face billing nightmares, and worse, federal scrutiny.  Reuters investigation has revealed that practitioners often go undetected as practitioners in one state after being involved with or kicked out of programs in another state. Reuters… Continue Reading

Inflated Medicare Payments

Posted in Medicare, senior care, Trial themes
The Banghor Daily News reported that the owner of several assisted living facilities will pay $300,000 to resolve a federal lawsuit charging it allowed a subcontractor, RehabCare Group East, Inc., to routinely submit inflated Medicare claims for rehabilitation.  The federal government charged that before Oct. 1, 2011, Rousseau submitted or caused the submission of inflated… Continue Reading

“Race To The Bottom”

Posted in Advocacy, Medicare, Trial themes
The New York Times had an interesting article on the “cutthroat race for Medicare dollars” and how it affects quality of care. Nursing homes are now marketing to sicker people to get Medicare dollars.  At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have… Continue Reading