False Claim Act Settlement with Visiting Physicians Association

Visiting Physicians Association will pay $9.5 million to settle for submitting false claims to Medicare, Medicaid and the military TRICARE medical program.  The doctors' group submitted false claims for unnecessary home visits, tests and procedures, as well as services that were never provided.   The claims were for people with Medicare, Medicaid and the military TRICARE insurance programs.   The settlement resolves four lawsuits filed by private plaintiffs under provisions of the False Claims Act, which permit private parties to file an action on the government’s behalf and share in any recovery. This settlement provides that the four whistle-blower plaintiffs will collectively receive a total of approximately $1.7 million.

Visiting Physicians Association, which has provided home health services in Michigan, Ohio, Georgia and Wisconsin, will make the payments to the U.S. government and the state of Michigan, to settle the allegations that it submitted claims for unnecessary home visits, unnecessary tests and procedures and other services it never provided.


 

Failure to properly transfer and provide emergency physician services

The L.A. Times had an article discussing the recent fine imposed on a nursing home facility.   Lakewood Manor North Nursing Home has been fined $100,000 after state officials concluded that poor care led to the injury and death of an elderly resident who fell and hurt his head.

The case involved a resident who lost his balance and struck his head on a bed rail when he was being transferred from his bed to a wheelchair. State officials said the facility failed to provide adequate support for the resident as he was transferred to his wheelchair.

At 8:30 a.m., about half an hour after the blow to the head, nurses' notes documented the man had a bluish discoloration on the left side of his head. The attending physician was paged at 8:45 a.m. and 12:30 p.m., but the doctor did not return the call. His condition continued to deteriorate throughout the day; he refused lunch and dinner and complained of not feeling well.  At 8:30 p.m., he was observed as lethargic. Finally, at an unspecified time, an attending physician was reached, and the patient was transferred to a hospital at 9:30 p.m.—more than 13 hours after he had struck his head. The patient had suffered bleeding in the brain and died five days later.

Investigators said the licensed nurses should have called either an alternate physician or the medical director when the attending physician did not respond to pages, or call 911 in an emergency.

“Failure of the facility staff to immediately notify the physician and to provide the necessary care and services to Resident 1 [the patient] ... presented a substantial probability that serious harm would result, and did result to Resident 1 [the patient’s] death,” the report said.
 

New study reveals need for more funding for alternatives to nursing home care

 Senior citizens who do not have children to help care for them are less likely to have to go into a nursing home if they live in a state that spends more on home- and community- based services found.   Researchers at the University of Illinois at Chicago report the finding in the May 11 issue of the Journals of Gerontology: Social Sciences. 

Naoko Muramatsu, associate professor of community health sciences at the UIC School of Public Health and lead author of the study stated  "There has been little evidence, prior to this study, to show that spending more money on these services helps seniors avoid or delay placement in a nursing home."

Some states spend as little as $35 per person each year on home- and community-based services for seniors, while other states spend more than $1,300 per person annually, according to previous research.

Regardless of how much was spent on home- and community-based services, the researchers found that doubling states' spending on services would reduce the risk of nursing home admission among childless seniors by 35 percent. 

The study was funded by the National Institute on Aging, one of the National Institutes of Health.


See journal article here

Medicaid is failing our elderly

A new report shows that Medicaid programs are failing to deliver adequate medical services to the low-income populations they were designed to serve including nursing home residents.  The non-profit consumer advocacy organization Public Citizen issued a report ranking Medicaid programs by how they met and surpassed federal mandates in four categories: eligibility, scope of services, quality of care and provider reimbursement.

Fifty-five million, mostly low-income Americans get their health care coverage through their state Medicaid program. The worst Medicaid programs in the country, according to Public Citizen, are those in Alabama, Colorado, Idaho, Indiana, Mississippi, Missouri, Oklahoma, South Carolina, South Dakota and Texas.

Public Citizen ranked states by the optional health care services that states provide beyond legally mandated services.
"Medicaid desperately needs nationwide uniform standards of quality of care and an effective means of monitoring and upholding those standards," said Ms. Ramirez de Arellano.

See story here

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