Editor’s Note: This article has been modified from its original version to clarify a quote from the California Association of Health Facilities.
A California citizens group has filed a lawsuit against the state over its alleged failure to combat “patient dumping,” in which nursing homes elbow out Medi-Cal, the state’s Medicaid program, beneficiaries in favor of more lucrative Medicare and private pay patients.
In its lawsuit, filed Monday, the California Advocates for Nursing Home Reform claim the state has turned a blind eye to a federal law that requires nursing homes to offer readmission hearings for patients who wish to return to the facility after a hospital stay. Refusing to enforce readmission orders violates the Nursing Home Reform Act, but the practice has persisted for years, the lawsuit claims.
CANHR’s suit was filed on behalf of three nursing home residents from across the state, who won their readmission hearings this summer but were refused readmission to their previous nursing homes. Those residents either sought admission at other skilled nursing facilities, or remain in the hospital. The total cost to the state for Medi-Cal patients who were left in a hospital, rather than being discharged into a skilled nursing facility, is over $70 million, the suit claims.
“In the strongest terms possible, we reject allegations that patient admissions or discharges are tied to payor sources,” Deborah Pacyna, director of public affairs for the California Association of Health Facilities told McKnight’s. “In California that argument doesn’t hold water, particularly because 66% of our nursing home residents are on Medi-Cal. In this state we are required to keep a bed open for seven days if a patient is hospitalized, and after that they are still entitled to return to the facility.”
CANHR seeks an injunction against the state Department of Health and Human Services’ lack of readmission order enforcement, and unspecified damages.