South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

Seattle PI reported the arrest of Gloria Corpuz Hall who was the operator of a Federal Way home for the elderly.  She is facing felony theft charges on allegations that she stole thousands of dollars from a deceased resident.  Prosecutors contend Gloria Corpuz Hall stole $21,775 from the accounts of an elderly woman who had been living at Hall's adult family home, Liberty Adult Care.

According to charging documents, Hall -- a 54-year-old Federal Way resident also known as Gloria Castillo Corpuz -- began drawing money from the woman's accounts months after her death on Jan. 21.  A review of the woman's bank statements, the detective continued, showed Hall had transferred money or forged checks on the woman's accounts at least 20 times.

Hall is alleged to have admitted to the thefts when confronted by police. Writing the court, the Federal Way detective said Hall complained that "she was behind on her mortgage and needed the money."  Charged with only one count of first-degree theft, Hall has not been jailed in the case
 

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New Jersey Newsroom had an article about nursing home operator Victor Napenas pleading guilty to Medicaid Fraud.  Napenas owned Valley Rest Nursing Home in New Jersey.  A state investigation discovered that he billed the Medicaid program for $302,877 in improper and unsubstantiated costs, including more than $100,000 in personal expenses.  The investigation began when state Department of Health and Senior Services (DHSS) surveyors noted severe deficiencies in the care delivered to residents.  The investigation discovered that the cost report included at least $302,877 in improper charges, including personal expenses and other amounts Napenas could not document or prove were spent for patient care.  Napenas issued business credit cards to himself and his wife through the nursing home, which they used for personal purchases, including trips to the Philippines, dance lessons and large family dinners. Napenas had those credit card charges and other personal expenses totaling more than $100,000 inserted into the cost report, resulting in reimbursement from Medicaid.

In pleading guilty, Napenas admitted that he fraudulently obtained payment from Medicaid for personal expenses unrelated to patient care. Prosecutors will recommend that Napenas be sentenced to only 90 days in a county jail as a condition of three years of probation. He must pay $302,877 in restitution to the Medicaid program, $45,263 in penalties, and $31,859 in provider taxes owed to the state. He will be prohibited from acting as a Medicaid provider for eight years.   Why should he ever be allowed to be a health care provider?

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Several media outlets have reported the $16 million settlement between Maryland and the nursing home industry including Consumer Affairs, The Baltimore Sun and the Washington Post.  Nursing homes sued Maryland for more money.  The average monthyl rate Medicaid pays for nursing home care is over $6,000.  The class action lawsuit, filed in August 2005, claimed that the state's Department of Health and Mental Hygiene erroneously concluded that nursing home residents could afford co-payments for their care. That determination failed to take into account the debt that patients accrued while waiting to be approved for Medicaid coverage, according to the suit. Federal and state law requires states to consider patients' debt when calculating their income.

Maryland taxpayers will provide $8 million of the settlement funds, with the federal government paying the other half. Nursing homes claimed that the state owed $64 million for incorrect calculations made since 2002.

The settlement could serve as precedent for other states that fail to take patients' old debt into account when determining their Medicaid eligibility. In order to qualify for Medicaid, the federal-state program for the poor, an individual must deplete his or her assets to reach a $2,000 threshold. Often, that patient needs care before reaching that limit and can accumulate thousands of dollars in nursing home bills.

Consumers can obtain information at the official settlement website

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The Wall Street journal had an interesting article about Omnicare's legal troubles.  Mr. Gemunder's was CEO of Covington, Ky.-based Omnicare, the nation's largest dispenser of pharmaceuticals to nursing homes serving 1.4 million beds in 47 states.  Obviously, Omnicare gets its profits from Medicare, Medicaid and health insurance.

Mr. Gemunder had been in charge since 1981, but recently retired with a large lump-sum pension payout.  He's getting a $91 million pension payout, plus severance, vesting of restricted stock  that bring his final payday to at least $130 million. And that's on top of the $14 million he bagged last year.

And what did the shareholders get for their money? Omnicare shares took a tumble last week after the company reported a shocking drop in the number of prescriptions it fills.

And what did the taxpayers and customers get? Omnicare has litigation costs amid evidence of kickback and billing schemes.  For example, in November 2009, Omnicare announced it would pay $98 million to settle a civil case brought by the Justice Department that it paid kickbacks to nursing homes and took kickbacks from pharmaceutical companies, including Johnson & Johnson. Omnicare also agreed to pay $49.5 million in 2006 to settle Medicare fraud claims. And last month, new details emerged in a continuing kickback lawsuit in Illinois.

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NY Times had an article about cuts in home-care services for elderly and disabled because of budget shortfalls despite the fact that programs have been shown to save states money in the long run because they keep people out of nursing homes.

Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.

States that have made cuts:

Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents.  State legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.

¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.

¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.

¶Arizona sliced independent living supports and respite programs for family caregivers.

¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.

In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.

Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.

In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents.

Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.

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The Centers for Medicare & Medicaid Services posted payment updates for skilled nursing and inpatient rehabilitation facilities' prospective payment systems for fiscal 2011. Nursing homes will realize a 1.7% increase in its market basket rate.  The nursing home increase was actually 2.3%, but federal regulators noted that an automatic click down of 0.6% was put into effect because overpayments were made at that rate in fiscal 2009. The net nationwide gain in Medicare payments to skilled nursing facilities will be $542 million in fiscal 2011.

CMS would be putting MDS 3.0 into effect on Oct. 1, which will modify resident assessment tool. As previously indicated, the RUGs-IV refined payment system will begin at the same time but will be recalibrated in the future, after CMS devises an appropriate way to recalibrate payments.

The SNF and IRF payment updates for fiscal 2011 will be officially published in the Federal Register. 

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The Providence Journal had a great article on a government program ––called Shared Living––  which is part of Rhode Island's effort to save nursing-home costs while allowing people to stay in their homes.  States have been offering the Shared Living program for people with developmental disabilities and now is expanding the concept to frail elderly people and adults with disabilities who are eligible for Medicaid. The first participants are expected to be paired up in about four weeks.

Through two agencies selected by the state, the program provides caregivers with money ($13,000 to $18,000 a year, nontaxable), nurses, caseworkers, training and respite. The caregiver lives with the elderly or disabled client and helps with such tasks as bathing and dressing. Typically the caregiver and patient know each other, may be related and may already be living together.

Shared Living bolsters efforts to care for people at home so they are less likely to need a nursing home. “It’s not just the money, but the support behind it,” said Jane E. Korb, program director for the Homestead Group, one of the two companies that will run the program. The other is Caregiver Homes of Rhode Island.

In Rhode Island, the Shared Living program sprang from the state’s “global waiver” to its Medicaid program, which frees the state from Medicaid rules to allow innovative programs.

The state has focused its efforts on reducing nursing-home use in favor of community-based programs. Long-term care accounts for nearly a third of Medicaid spending, and more than half of that long-term care money pays for nursing homes, according to 2007 data from the Kaiser Family Foundation.

The agencies that will run the program are not licensed. The Health Department has no oversight, even though it regulates nursing homes, assisted living and home care. The state Department of Human Services plans to monitor client and caregiver satisfaction, length of stay in the program, caregiver retention rates and complaints. 

The Homestead Group has been running the state’s Shared Living program for developmentally disabled people for years. Caregiver Homes is among the agencies that have been providing a similar service in Massachusetts. Its Rhode Island program director, David E. Bell, was formerly director of elder services at Child and Family Services of Newport County.

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The St. Louis American had an article about the prevalence of "hospital dumping" in St. Louis.  The article says that four times a week a nursing home resident calls in a panic because they were sent to the hospital for a medical or mental health condition. Then, when the hospital discharges the patients, the nursing homes won’t take them back.  This, of course, is against the law.  But the nursing homes don't care because the law is not enforced.

By law, skilled nursing facilities are required to give their residents a 30-day notice if they want them to leave the facility. 

If there is a reason why its staff can’t meet a resident’s medical needs, the facility should call the Missouri Department of Health and Senior Services.  However, the need is immediate and bureaucrats are busy.  Cheryl Wilson, director of the ombudsman services for the St. Louis Long-term Care Ombudsman Office, said the issue keeps her team running around in frantic circles all week, leaving them hardly any time to attend to other advocacy duties.

At Christian Hospital, in North St. Louis County, it happens “too many times not to be addressed by the State,” said Diana Tucker, social work case manager.

The State can’t quantify the number of cases because citations are not searchable by the type of violation.  The facilities say they would rather be cited by the State than take the resident back, Wilson said.

Both the ombudsman program and nursing homes are burdened with the surge in mental health patients. The State’s mental health care budget is dwindling every year. With psychiatric facilities closing, the patients are now moving into the nursing homes, Cheryl Wilson said.

This year, legislators severely slashed funds for the State’s two remaining psychiatric emergency rooms, as well as long-term care for people with mental illness and home care for the elderly.

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I ran across a couple of articles on Crystal Rader.  Born with muscular dystrophy, Rader requires a motorized wheelchair to get around.  Rader enjoys leaving the nursing home for activities and the wheelchair is the only way she can participate.  Her current wheelchair is six years old and ready to break down.   Rader bought it for $35,000 (with assistance of Medicaid) six years ago,

She applied to Colorado's Medicaid program for assistance for a new wheelchair. Medicaid denied her request, claiming in its rejection letter that the wheelchair is unavailable to her under the state's Durable Medical Equipment Program because she lives at the Fort Collins Health Care Center, a nursing home owned and operated by Sava Senior Care, therefore, the nursing home should provide the wheelchair and then presumably get reimbursed by Medicaid later.

"If they live in a long-term care or nursing facility, we do not pay for durable medical equipment unless that person is within 14 days of discharge," Department of Health Care Policy and Financing spokeswoman Joanne Lindsey said.   The state pays the Fort Collins Health Care Center for medical and equipment costs.

Rader said she isn't confident the Fort Collins Health Care Center, which is owned by Atlanta-based Sava Senior Care, will help her get a new chair.

"For a 26-year-old to be stuck in bed is horrible," Rader said. "It scares me. I lose all my activities I like to do."

I wonder why the local Ombudsman isn't involved?
A fund has been set up to help Crystal Rader replace her aging motorized wheelchair. 

See articles from the Coloradoan here and here.

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Karen Mason was the chief executive officer of Havenwood Nursing and Rehabilitation Center who has been sentenced to two years in prison for tax evasion. Federal prosecutors say 57-year-old Karen Mason, previously known as Karen Mueller, admitted taking more than $1 million from the Havenwood Nursing and Rehabilitation Center from 2002 through 2005 and not reporting the money as income.

The U.S. attorney's office says she used the money for jewelry, home furnishings, cars, entertainment, travel and other expenses, including more than $30,000 for a wedding and honeymoon for one of her children. It says she underpaid her federal income taxes by more than $360,000.

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