Omnicare profits triple

The Washington Post reported OmniCare's profits soared because of recent settlements for kickbacks decreased their anticipated legal defense costs.  Omnicare Inc., which dispenses drugs to nursing homes and long-term care facilities, said its profit almost tripled in the fourth quarter after it resolved allegations it paid kickbacks to nursing homes, and received money for buying and recommending drugs.

In June, Omnicare agreed to pay $98 million to settle the investigation. The terms were completed in November. The Justice Department said Omnicare paid $50 million to Mariner and Sava Senior Care owner/operators Murray Forman, Leonard Grunstein, and Rubin Schron to gain their business, while also asking for and getting kickbacks from two drug companies for recommending their products.

In the fourth quarter, the company said its profit rose to $80 million, or 68 cents per share, from $27.6 million, or 24 cents per share, a year earlier. Omnicare said it earned 74 cents per share from continuing operations, but that includes a tax benefit of 11 cents per share. Its revenue fell 2 percent to $1.54 billion from $1.57 billion

Analysts expected a profit of 63 cents per share and $1.55 billion in revenue, according to a Thomson Reuters survey.

The company reported a total of $5.7 million in pretax litigation costs in its latest quarter, compared to $48.1 million pretax a year ago.

Omnicare said its pharmacy services revenue fell 1 percent to $1.51 billion from $1.53 billion. The decline came from greater use of low-cost generic drugs, smaller reimbursement payments for certain drugs, and a decrease in the amount of beds served. The company said it did more business with assisted living facilities, which typically don't buy as many drugs as acute care centers or other facilities it does business with.

Revenue from Omnicare's clinical research business slipped to $34.3 million from $49.1 million.

In 2009, Omnicare said its profit jumped 51 percent to $211.9 million, or $1.80 per share, from $140.5 million, or $1.19 per share. Revenue decreased less than 1 percent to $6.17 billion from $6.21 billion.

 

 

Kickback Settlement

Numerous websites and news organizations have written about the recent settlement between the DOJ and Murray Forman, Rubin Schron, and Leonard Grunstein, owners and operators of hundreds of nursing homes through various entities such as Mariner, Sava Senior Care and Fundamental Long Term Care Holdings.  See articles and press releases here, here, here, here, here, here, here, here, here, here, here, and here.

What is incredible and disappointing about the settlement is the DOJ only made these criminals  pay $14 million but did not make them testify, admit guilt, payback the kickback, or take away their ability to continue owning and operating nursing homes.  What kind of penalty is $14 million when they have stolen millions more from Medicare and Medicaid?  Why did the DOJ make the now defunct Mariner pay but not their successor Sava Senior Care?   Why did they allow the Complaint to be dismissed before the settlement?  Why did they allow Forman and Grunstein, the masterminds behind the illegal scheme deny any responsibility or wrongdoing?  Why didn't they make Forman and Grunstein pay the kickback back to Medicaid and Medicare?

The settlement resolves the United States’ allegations that the defendants solicited and received kickback payments from Omnicare, Inc. (“Omnicare”), the nation’s largest pharmacy that specializes in dispensing drugs to nursing home patients.  

"As outlined in the government's complaint, Rubin Schron, Leonard Grunstein and Murray Forman tried to disguise an unlawful kickback payment," said Mary Louise Cohen, a Washington, DC, attorney with Phillips & Cohen LLP, which represents the whistle-blower. "Omnicare's $50 million payment for a small unit of Mariner Health Care -- which had less than $3 million in assets and only two employees -- just didn't add up without figuring out what else Omnicare was getting as part of the deal."

In a Complaint filed in March 2009 and unsealed in November 2009, the United States alleged that Omnicare, Mariner, Sava, Grunstein, Forman, and Schron conspired to arrange for Omnicare to pay $50 million in exchange for agreements by Mariner and Sava to use Omnicare’s pharmacy services for 15 years.   In 2004, Grunstein and Forman proposed that Schron provide financial backing for the acquisition of Mariner, which at that time was one of Omnicare’s largest customers. Grunstein and Forman attempted to arrange the Mariner acquisition so that Schron would have to contribute as little cash as possible. To achieve this end, Grunstein and Forman pursued a plan to sell to Omnicare the right to continue providing pharmacy services to Mariner, even though Forman was warned by lawyers that selling the right to provide pharmacy services would constitute an illegal kickback.

Grunstein and Forman thereafter arranged for Omnicare to pay them $50 million to purchase a  Mariner company that had only two employees and no tangible assets.  Omnicare paid $40 million of this amount up front, prior to actually acquiring the Mariner business unit, and simultaneously obtained new 15-year pharmacy contracts from Mariner and from Sava, a new nursing home chain that Grunstein and Forman created from Mariner. Grunstein and Forman illegally tied the new pharmacy contracts to Omnicare’s agreement to purchase the small Mariner business unit, and that the total $50 million purchase price for the business unit actually was a kickback by Omnicare to keep the future business of Mariner and Sava. In 2006, after the Government issued subpoenas concerning the transaction, the individual defendants created backdated documents in a further attempt to hide the kickback.

In November 2009, the United States and Omnicare entered into a $98 million settlement agreement that resolved Omnicare’s civil liability under the False Claims Act for paying kickbacks to keep the Mariner and Sava business.  So Forman and Grunstein coerced OmniCare to pay them a $50 million kickback and Omni had to pay $98 million but Forman and Grunstein and their companies only had to pay $14 million!?!

As part of the settlement, Mariner has entered into a corporate integrity agreement. This agreement provides for Mariner to put in place procedures and reviews to avoid and promptly detect conduct similar to that which gave rise to this matter. At the same time, OIG-HHS has reserved its rights to seek exclusions of Sava, Grunstein, Forman, and/or Schron from participation in Medicare, Medicaid, and all other Federal health care programs.

"I suspect that if you got [Grunstein, Schron and Forman] all in a room and asked them whose fault this was, they'd all be pointing at someone else," says one person familiar with the case. "And that's really what this transaction was about --setting up all these different entities and shells and moving pieces so that nobody had responsibility."

Rubin Schron, a New York real estate investor who along with National Senior Care Inc., bought Mariner Health Care Inc., which is at the center of the kickback scheme. -- Leonard Grunstein, a New York real estate attorney who was a partner with the law firm, Troutman Sanders. He was Schron's agent in the purchase of Mariner Health Care Inc. and in the alleged kickback scheme. -- Murray Forman, an associate of Grunstein's and Schron's who also is president of a Long Island school board. -- Mariner Health Care Inc., a Delaware corporation with headquarters in Atlanta, Georgia, that operates nursing homes and, according to the government's complaint in this case, is controlled by Schron. -- SavaSeniorCare Administrative Services LLC, a privately held Delaware company with headquarters in Atlanta, Georgia, also reportedly controlled by Schron. Sava affiliates lease and operate nursing homes.

This settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $2.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion


 

Jay Reinan v. Mariner

Below is a great old article about attorney Jay Reinan from Colorado who fought on behalf of John Gordy against the infamous Mariner chain.  Reinan had been a nursing home defense lawyer until he saw the light.   Here is the full article. 

John Gordy's story is tragic and typical of many residents in nursing homes.   He was neglected and abused by those he entrusted with his safety and care.   In 2002 he was admitted to the Red Rocks facility.  Right away, things started going wrong. Though Red Rocks' advertising promised excellence in wound care, Gordy felt like he had to train every new aide who walked into his room. And because of constant turnover, there were many. An ulcer on his foot was ignored to the point of needing surgery. Twice. He almost died after being given the wrong antibiotic. He was forced to lie helpless, despite his protests, as a hot towel scalded the flesh of his chest, leaving him with second-degree burns -- an attempt to warm him when the heat at the facility was broken. But nothing was as bad as the nighttime. Gordy's call light was his only defense in an emergency, but it took aides hours to answer. One night he was left near the side of his bed, with the bed rail down. As he felt himself sliding toward the edge, he yelled out for help, knowing it would only be a matter of time before he fell. He screamed all night, but no one came. At the 6 a.m. shift change, someone finally checked on him; just as the aide entered the room, Gordy crashed off the bed and landed on his face, smashing his teeth.

Jerome "Jay" Reinan is a Denver lawyer who spends his days fighting for abused and neglected clients such as John Gordy, wasn't always on the side of right.  He used to work for what he calls "the dark side," defending corporate nursing homes against such claims. "I was probably one of the primary nursing-home defense lawyers in the state before I switched over," he says matter-of-factly. 

Despite courtroom successes, there were early signs that defense work didn't suit Reinan. He didn't like not being able to choose cases, and he hated that clients were billed on an hourly basis. "You have to keep track of every minute," he says. "If I was on a phone call with a client, I would have to have a piece of paper or a computer program where I kept track of every second I was talking to that person, and it drove me nuts."

It wasn't until 1996 that Reinan took the case that would end his career in nursing-home defense. It started with the families of four residents of Cedars Health Care Center in Lakewood but would grow to include everyone who had lived there between 1993 and 1998, nearly 200 people. During the course of the litigation, the nursing home's owner went through a series of mergers to create Mariner Post-Acute Network. The sheer size of the case was overwhelming, and it absorbed almost all of Reinan's efforts as well as that of one of his partners and two associates. But in the midst of the massive undertaking, Mariner stopped paying its legal bills -- $250,000 worth. (The company would file for bankruptcy in 2000 and emerge as Mariner Health Care Inc. in 2002.) "The mentality you get into on the defense side is, if you have one big client, you're going to kiss that client's butt," Reinan says. "Even if they're not paying the bills on time or they're cutting your bills back, you just have to take it."

But Reinan didn't want to take it anymore. He knew if he was ever going to switch sides and represent people injured by nursing homes, the time was right.  Reinan fired Mariner and demanded payment for what he was owed. His partners protested, but he told them it was his client, his decision. Mariner eventually paid, but the partners split, and Reinan started his own practice in October 1999.

Jay Reinan accepted a case against Red Rocks Healthcare Center for allowing resident Chris Tisserat to starve and dehydrate. But when he filed suit, he got an interesting call from Mariner Health Care Inc., Red Rocks' owner and the company he once represented. "I get a call from their national counsel saying Mariner's almost going bankrupt. They're running out of money and can't pay very much for this claim. 'You'd better take what I'm offering today because it may not be here tomorrow.'"

So he did. Reinan knew if he held out for more and the company filed for bankruptcy protection, his client might end up with nothing. His mistake in taking the bait didn't occur to him until months later.

In summer 2005, John Gordy's case against Red Rocks was referred to Reinan. It was exactly the type of case that Reinan prefers to take. Not only could he show what horrors Gordy had suffered, but records from the Colorado Department of Public Health and Environment showed a pattern of substandard care. Between 2002 and 2005, Red Rocks had been cited with seven deficiencies for failure to prevent or treat pressure sores, five deficiencies for failure to adequately maintain clinical records on residents, and four for failure to prevent falls. Across the state, nearly all of Mariner's thirty nursing homes were cited with serious deficiencies. Eleven were cited for pressure sores at a time when the company was promising superior wound prevention. In fact, the company had such a bad record that the U.S. Department of Health and Human Services had previously sued it for fraud because Mariner facilities hadn't provided the minimum standard of care required by Medicare and Medicaid.

In early 2002, Mariner paid $26 million in fines and entered a Corporate Integrity Agreement with the Office of the Inspector General. A 47-page document specifies every care and accountability standard that Mariner facilities must meet if the company wants to keep its Medicare and Medicaid checks coming.

As Reinan prepared to file Gordy's case, he thought about his last settlement with Mariner. He assumed the company had managed to avoid bankruptcy, as he hadn't heard any more talk of an impending filing. He ran a simple Internet search in late 2005 to check the company's status and found that Mariner hadn't been paying creditors or even its own attorneys: Gulf South Medical Supply was suing Mariner for nearly $5 million it was owed for supplies, and Brunini, Grantham, Grower and Hewes PLLC, a defense firm in Mississippi that represented Mariner, was suing the company for nearly $1 million owed in legal bills. Reinan was glad he had fired Mariner as a client when they owed him only $250,000.

He also found that a group of real-estate investors had formed a company called National Senior Care Inc. in order to purchase the publicly traded Mariner Health Care Inc. The $1 billion deal that went through in December 2004 was a leveraged buyout, as NSC sold off much of Mariner's real-estate assets -- 180 facilities -- to finance the sale. Interestingly, the owners of the companies who bought the assets have ties to NSC, including Leonard Grunstein whose brother is NSC president Harry Grunstein. That sale left the now-privately owned Mariner -- which continued to operate under its own name -- a shell of its former self, worth only $5 million to $12 million, compared to its earlier billion-dollar valuation. Separating the real-estate holdings from the actual health-care operation had an upside for the company's new owners: It reduced their exposure to liability lawsuits, because such cases can only be filed against the company holding the license to provide care, and Mariner's post-sale bottom line looked too emaciated to afford big payouts.

When Reinan took a closer look at the ownership of Red Rocks Healthcare Center, he found a tangled web of companies. But as he traced back the licensure documents, he noticed that the same names kept reappearing: real-estate moguls Harry and Leonard Grunstein and Rubin and Avi Schron. "The land is owned by a company owned by these four guys, and the building is owned by another company owned by these four guys, and the staff is managed by a company that is owned by these four guys. Then there's layers of companies that lease the staff and the building to other companies owned by these four guys, and pretty soon you have something like literally ten or twelve companies that all have their little fingers in running Red Rocks Healthcare Center," he says.

"Why do they do that? It allows them to own all the assets that used to be Mariner, but at the same time avoid liability to the people they hurt, maim and kill at their facilities."

Reinan amended the complaint in the Gordy suit, adding all the specific companies involved and their individual owners. He also included that long list of defendants in a new lawsuit on behalf of Peggy Mussehl, whom he claimed was neglected at another Mariner facility, Fort Collins Health Care Center.  Reinan got a call from Mariner's local attorney, a former colleague, assuring him that adding the additional companies and individuals as defendants would only complicate and drag out the case. It wasn't necessary, he explained, because Mariner had liability insurance.

Reinan agreed to dismiss the extra parties from the complaint, with a warning: "If I hear a whiff of evidence from anyone that Mariner doesn't have money, Mariner doesn't have insurance, I'm going to refile this thing pronto."

A month later, in March, Reinan got a letter in the mail from Martin Stein in New York, the same man who had urged him to settle the Tisserat suit: There are currently approximately 300 open claims against the Mariner entities, alleging injury and/or loss. These include many high exposure cases which are scheduled for trial over the next few months. With respect to almost all of these cases, including the above-captioned matter, there is no insurance available for the first $1 million of loss (including fees and expenses). This means that any judgment in such cases up to $1 million (less fees and expenses incurred) will have to be satisfied from the Mariner assets, if any, available at the time of judgment.

Under the circumstances, I hereby offer $35,000 to settle the [John Gordy] case on behalf of Mariner and its related entities.Š Finally, please be advised that on February 8 and 9, 2005, Mariner won three defense verdicts in professional liability cases, two in Florida and one in Texas.

Two days later, Reinan received the same form letter regarding the Mussehl case. As part of Colorado's tort reform in 1986, nursing homes and other medical facilities were required to obtain insurance as a trade-off for caps being set on awards. Colorado law now requires each nursing home to have at least $3 million in insurance, so Reinan requested the licensure information from the state health department. In the affidavits, signed in 2005, company officials had sworn that each facility had the necessary insurance.

Stein maintains that he has "never said that Mariner does not have insurance" and has "never sent a letter to any attorney on behalf of Mariner saying that Mariner doesn't have any insurance." When asked to clarify the content of the letter, he refused and hung up the phone. Attempts to contact Mariner's in-house counsel and Leonard Grunstein, who is named individually in Reinan's complaints, were unsuccessful. 

Reinan suspects that the new owners are hoping trial lawyers will shy away from claims against Mariner once they find that there's no money and no insurance. Most attorneys would rather take cases against financially sound companies with whom they can settle quickly. In April, Reinan again amended his complaints against Mariner to add the individual owners and associated companies, then filed a new suit in federal court.

Reinan also sent letters to the Colorado Department of Public Health and Environment, the Colorado Department of Regulatory Agencies Division of Insurance and the U.S. Office of the Inspector General detailing what he knew about Mariner's insurance situation and including copies of his letters from Stein and the affidavits submitted to the state health department. "Obviously, one of two things has happened," he wrote. "Either Mariner is employing fraudulent insurance-claims tactics by pretending it has no money in order [to] save on claims payments, or Mariner truly has no money and no insurance, and the affidavits issued by [company officials] are phony and fraudulent. In either case, the State of Colorado must investigate this matter."

 



 

A Tangled Web of Greed and Deceit Part 2

Today I want to write about the people and entities involved in this kickback scheme. 

Murray Forman is the principal owner and decision maker for hundreds of nursing homes throughout the country including the Mariner, SavaSeniorCare, GranCare, and THI/Fundamental chains. Leonard Grunstein is a real estate lawyer and partner at Troutman & Sanders.  Rubin Schron is an owner of the Woolworth Building.

The Atlanta Journal Constitution had an article about the trio above.  Leonard Grunstein is a prominent attorney at Atlanta-based Troutman Sanders named in a federal complaint charging he and several other parties, including two companies with Atlanta ties, were involved in a $50 million kickback scheme to steer nursing home patients to OmniCare.  Leonard Grunstein, a New York-based partner at Troutman Sanders and leader of the firm's real estate capitalization and investments practice groups, was named in the complaint.  In an e-mail statement, Troutman Sanders spokesman Mark D. Braykovich said Grunstein is taking a leave of absence until the matter is resolved.

Also named is Grunstein's business associates Rubin Schron and Murray Forman, both of New York; Atlanta-based Mariner Health Care Inc. and SavaSeniorCare Administrative Services, which also is headquartered in Atlanta.

According to the detailed 32-page Complaint, Omnicare paid Mariner and Sava $50 million in 2004 to get them to sign long-term pharmacy contracts and steer nursing home patients -- including those covered by Medicare and Medicaid -- back to it for pharmacy dispensing services.

The scheme allegedly worked this way, according to the complaint:

Mariner, one of the nation's largest nursing home operators with more than 263 assisted living facilities, announced in June 2004 it was selling itself to National Senior Care Inc. for $1 billion. National Senior Care, which is headed by Grunstein's brother, Harry, was created solely for that transaction. It is an affiliate of SavaSeniorCare.

Forman and Leonard Grunstein subsequently proposed Omnicare purchase a Mariner subsidiary, Mariner Medical Supply, for $50 million. If Omnicare didn't, it would lose the pharmacy services contract it had with Mariner after the sale to National Health Care.

Omnicare executives raised the concern about such a transaction being perceived as a kickback but agreed to the deal because it risked losing $155 million in revenue and $26 million in operating profit a year on the three years it had left in the contract with Mariner.

Crain's New York Business had an article discussing the complaint and allegations.  The Complaint says the above men were part of a trio who received a $50 million payment from Omnicare Inc., the nation's largest nursing home pharmacy, so it could continue to provide services to their nursing home companies, Mariner Health Care and Sava Senior Care. The government alleges the trio attempted to disguise the $50 million from Omnicare as a payment to acquire a business unit from Mariner that in fact only had two employees and was worth far less than $50 million.

The San Jose Mercury News had an article with a great quote from a DOJ official.  "Illegal conduct like this can undermine the medical judgments of health care professionals, lead to patients being prescribed medications they do not need, and drive up the costs of health care," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. The agency added that Omnicare specializes in providing drugs to homes caring for dementia and Alzheimer's patients, who have little control over their medications.

 

 

A Tangled Web of Greed and Deceit

My next three entries will discuss the exploits and complaints against OmniCare, Mariner, SavaSeniorCare, and Murray Foreman, Rubin Schron, and Leonard Grunstein who own and operate hundreds of nursing homes through a complex maze of corporate shenanigans, and were finally caught gaming the system to make millions and deprive our loved ones of the necessary care they deserve.  Our taxes are going into the pocket of these greedy corrupt men.

There have been numerous articles on these cases and I will try to organize, summarize, and paraphrase most of them in the next three days.  It is interesting that none of the article discusses Murray Foreman and Leonard Grunstein's ownership of Fundamental Long Term Care Company that owns and operates hundreds of other nursing homes using the THI name.

The Wall Street Journal wrote geriatric pharmacy company Omnicare Inc. will pay $98 million to settle charges that it engaged in several kickback schemes with drug makers and nursing homes.  The Justice Department alleged that Omnicare regularly paid kickbacks to nursing homes in order to induce the homes to refer their patients to Omnicare for pharmacy services.  Separately, the department said it was intervening in a lawsuit alleging that two nursing-home chains, Mariner Health Care Inc. and SavaSeniorCare Administrative Services, accepted kickbacks from Omnicare in return for pharmacy-service contracts.

Reuters had an article that added additional facts.   DOJ filed a complaint against two large nursing home chains, Mariner Health Care Inc. and SavaSeniorCare Administrative Services LLC, both of Atlanta, and their principals, Leonard Grunstein, Murray Forman, and Rubin Schron, for accepting a kickback from Omnicare in return for pharmacy services contracts.  The company allegedly solicited and received kickbacks in exchange for agreeing to recommend that physicians prescribe Risperdal, a  dangerous antipsychotic drug, to nursing home patients.

The government further alleged that Omnicare regularly paid kickbacks to nursing homes by providing consultant pharmacist services at rates below the company's cost and below the fair market value of such services in order to induce the homes to refer their patients to Omnicare
for pharmacy services.

The United States alleges that Omnicare, Mariner Health Care, SavaSenior Care, Grunstein, Forman, and Schron conspired to arrange for Omnicare to pay the nursing home chains $50 million in exchange for the right to continue providing pharmacy services to the nursing homes, which together constituted one of Omnicare's largest customers. Defendants attempted to disguise the $50 million kickback as a payment to acquire a small Mariner Health Care business unit that had only two employees and was worth far less than $50 million.

After they became aware of the government's investigation, Grunstein, Forman, and Schron allegedly created false backdated documents in a further attempt to hide the kickback. These
allegations are detailed in a separate complaint that was unsealed recently.  Read the Complaint here.

More to come tomorrow.

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