State sues, alleging operator dumped residents to increase yield from more lucrative patient sources
MARYLAND — Attorney General Brian E. Frosh is suing a nursing home operator for allegedly expelling residents to free up higher-reimbursed Medicare beds. Frosh filed the suit in Montgomery County Circuit Court in late December.
The attorney general said his office’s investigation also revealed Neiswanger Management Services booted residents after their Medicare coverage expired without finding suitable alternative care, dropping some off at homeless shelters and other “inadequate” locations. The federal government pays facilities $500 a day for Medicare patients, nearly twice that of lower public insurance.
Frosh’s investigators found NMS discharged residents at twice the rate of the 225 other homes in the state combined over a 17-month period ending May 31. The 62-page lawsuit alleged that NMS “aggressively” sought hospital-discharged Medicare patients and worked just as fast to get them out when their coverage ended.
Frosh also alleged that NMS justified the discharge notices on the basis the residents failed to pay or failed to arrange for payment by Medicare, Medicaid or a third-party payer, even though some were still eligible to receive Medicaid care.
NMS Chief Executive Mark Yost strongly disputed the allegations in Frosh’s suit.
Protests delay MA programs
PENNSYLVANIA — Shunned bidders for a share of the state’s lucrative $5.4 billion Medicaid managed care business forced a six-month delay in a controversial plan that could affect the delivery of long-term-care services, nursing home stays, home care and other programs for the disabled and elderly.
The state went out to bid last year on the overhaul program leading to Medicaid managed care — a plan scheduled to take effect July 1, 2017. But losing bidders Gateway Health Plan, Molina Healthcare and UnitedHealthcare appealed the results, leading the Legislature to push back implementation until 2018. The new program will be called Community HealthChoices.
Winning bidders included AmeriHealth Caritas, a subsidiary of Independence Health Group; a unit of Centene Corp.; and UPMC for You, which is owned by the University of Pittsburgh Medical Center. It’s not yet known if the losing bids will be reconsidered.
1 in 3 not vaccinated
MASSAChUSETTS — About one-third of employees in the state’s nursing homes, adult day centers and clinics declined to be vaccinated for influenza for the 2015-2016 flu season.
More than two-thirds of the state’s 419 nursing homes reported about 73% of their workers had been vaccinated. State hospitals, meanwhile, exceeded the national goal by vaccinating 92% of workers.
Unions representing nursing home workers support vaccinations but oppose mandating them, according to reports.
Licensing delays drag on
NEW HAMPSHIRE — Hundreds of work-ready nurses remain idle over licensing delays that some claim have plagued the state for too long.
A recent New Hampshire Health Care Association survey reported that 74% of LNA candidates experienced difficulties obtaining their license from the state’s Board of Nursing. Facility complaints centered on inability to hire work-ready candidates. About 18% said their candidates were waiting more than a month for a green light.
Officials blame the delays partially on implementation of a new computer system and backlogs in background checks with the state police.
DOJ: integrate mentally ill
LOUISIANA — The U.S. Justice Department says the state’s healthcare system is placing too many mentally ill individuals in nursing homes instead of more suitable care settings.
The department claims such practices violate the community integration mandate of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., which require caregivers to place mentally disabled individuals in the most “appropriate” community settings for their condition. Current practices reveal a woeful lack of such settings, the department said in a statement.
Justice representatives praised Louisiana officials for cooperating in efforts “to ensure that residents with serious mental illness who qualify for state services can live successfully in their communities with appropriate supports.”
Pay for the dead
FLORIDA — The state has recovered all but $2 million of the $26 million the Medicaid program paid over five years to cover already deceased individuals, according to published reports.
Much of the erroneous billing was the result of outdated state databases and poor multi-agency collaboration, according to the Office of the Inspector General for the U.S. Department of Health and Human Services. The payments occurred while the state was transitioning to a privately-run Medicaid managed care program from 2009 to 2014, the Miami Herald reported.
$1B cut as Medicaid expands
ARKANSAS — The state will reportedly trim $1 billion in Medicaid spending over the next five years to make up for additional expenses of expanding its own program under the Affordable Care Act.
More than 300,000 state residents could be impacted by the plan, which would cut, among other things, $205 million from programs for the disabled, $215 million from mentally ill services and $250 million each from programs for prescription drugs and programs for the elderly.
Workers allege retaliation
ILLINOIS — Former nursing home social workers say they were terminated from their jobs for refusing to fabricate records that would have concealed abuse and neglect, according to published reports.
Kenneth Allen and Olufunmibi Ogunyipe filed suit in Cook County Circuit Court last November against Bria of River Oaks nursing facility in suburban Chicago. A Chicago Tribune report said some of their abuse claims were investigated by the Department of Public Health.
Bria of River Oaks CEO Avrum Weinfeld declined to comment on specifics but said the allegations were baseless.
VA allegations probed
WISCONSIN — Lawmakers and state health officials are continuing to look into a series of care complaints at a state-run veterans nursing home in King, and adverse events at the VA Medical Center in Tomah, including alleged exposure to HIV.
In recent years, the Tomah VA Medical Center was reportedly linked to cases of unsafe drug prescription practices, one allegedly involving 54 doses of 13 drugs on a resident three days before his death. Even after a legislative inquiry into the death led to personnel and procedural changes, reports later alleged that hundreds of patients there may have been exposed to HIV after dental instruments were improperly sterilized. Lawmakers have asked the U.S. veterans affairs secretary to investigate the dental care issues.
An audit was ordered at the King facility for alleged food safety violations and medical errors, and complaints of alleged problems with staff not adequately trained to deal with suicidal or violent residents.
Auditor rips nursing board
CALIFORNIA — The state’s Board of Registered Nursing is under fire for delays in investigating and resolving serious negligence complaints. The state auditor told reporters the delays could pose health threats.
In a scathing 67-page report issued in mid-December, the auditor recommended moving the enforcement work of the nursing board to the state Department of Consumer Affairs if a plan to resolve the delay issue is not offered by March 1. A total of 1,766 investigations were reportedly launched in 2014 and 2015.
The agency is determined to correct the problem, a state nursing board spokesperson told reporters.