The Abject Failure of Nursing Homes in US to Report Thousands of Elder Abuse and Neglect Cases – and a Lack of Oversight

U.S. nursing homes failed to report thousands of elder abuse and neglect cases, report

WASHINGTON — Nursing facilities have failed to report thousands of serious cases of potential neglect and abuse of seniors on Medicare even though it’s a federal requirement for them to do so, according to a watchdog report released Wednesday that calls for a new focus on protecting frail patients.

Just 2 of 69 cases checked in five states were reported to local law enforcement

Auditors with the Health and Human Services inspector general’s office drilled down on episodes serious enough that the patient was taken straight from a nursing facility to a hospital emergency room. Scouring Medicare billing records, they estimated that in 2016 about 6,600 cases reflected potential neglect or abuse that was not reported as required. Nearly 6,200 patients were affected.

“Mandatory reporting is not always happening, and beneficiaries deserve to be better protected,” said Gloria Jarmon, head of the inspector general’s audit division.

Overall, unreported cases worked out to 18% of about 37,600 episodes in which a Medicare beneficiary was taken to the emergency room from a nursing facility in circumstances that raised red flags.

Responding to the report, Administrator Seema Verma said the Centers for Medicare and Medicaid Services does not tolerate abuse and mistreatment and slaps significant fines on nursing homes that fail to report cases.

Verma said the agency, known as CMS, is already moving to improve supervision of nursing homes in critical areas such as abuse and neglect and care for patients with dementia.

CMS officially agreed with the inspector general’s recommendations to ramp up oversight by providing clearer guidance to nursing facilities about what kinds of episodes must be reported, improving training for facility staff, requiring state nursing home inspectors to record and track all potential cases and monitoring cases referred to law enforcement agencies.

Neglect and abuse of elderly patients can be difficult to uncover. Investigators say many cases are not reported because vulnerable older people may be afraid to tell even friends and relatives much less the authorities. In some cases, neglect and abuse can be masked by medical conditions.

The report cited the example of a 65-year-old woman who arrived at the emergency room in critical condition. She was struggling to breathe, suffering from kidney failure and in a state of delirium. The patient turned out to have opioid poisoning, due to an error at the nursing facility. The report said a nurse made a mistake copying doctor’s orders, and the patient was getting much bigger doses of pain medication as a result. The woman was treated and sent back to the same nursing facility. The nurse got remedial training, but the facility did not report what happened. The report called it an example of neglect that should have been reported.

The nursing facilities covered by the report provide skilled nursing and therapy services to Medicare patients recovering from surgeries or hospitalization. Many facilities also play a dual role, combining a rehabilitation wing with long-term care nursing home beds.

Investigators said they faced a challenge scoping out the extent of unreported cases. They couldn’t query a database and get a number, since they were looking for cases that weren’t being reported to state nursing home inspectors.

To get their estimate, auditors put together a list of Medicare billing codes that previous investigations had linked to potential neglect and abuse. Common problems were not on the list. Instead it included red flags such as fractures, head injuries, foreign objects swallowed by patients, gangrene and shock.

The investigators found a total of 37,600 records representing 34,800 patients. Auditors then pulled a sample of cases and asked state inspectors to tell them which ones should have been reported. Based on the expert judgment of state inspectors, federal auditors came up with their estimate of 6,600 unreported cases of potential neglect and abuse.

Investigators found that nursing facility staff and even state inspectors had an unclear and inconsistent understanding of reporting requirements.

Medicare did not challenge the estimates but instead said that billing data comes with a built-in time lag and may not be useful for spotting problems in real time.

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The Depraved Indifference in Nursing Care – The Ashmedai – The Owners Who Choose Profit Over Care – Part I

The word “Ashmedai” it is said is used to refer to the King of the demons – all that is evil. “The author of the Ra’aya Meheimna in the Zohar (3:253a) distinguishes between three types of demons: (1) those similar to angels; (2) those resembling humans and called shedim Yehuda’im (“Jewish devils”) who submit to the Torah; (3) those who have no fear of God and are like animals.” [https://www.jewishvirtuallibrary.org/demons-and-demonology]

nursing fraud

[EDITORIAL – IN HONOR OF SHAVUOT AND THE ELDERLY AROUND THE COUNTRY WHO NEED OUR HELP] (updated 6.10.19) (updated 6.11.19)

Nursing Home Scandals in the US – A Special Duty Should be Required in Nursing Care and a Special Class of Punishments Established for Those Who Abuse

Nursing home care is a profitable business. There are “nursing home” moguls chomping at the bit to get hold of another for his or her portfolio. There are those owners/managers with their names on dozens of homes. There are straw-men who act as placeholders so the majority owners don’t need to report. It is a racket.

While the US government is supposed to restrict owners with repeated complaints from acquiring additional homes, those who are serially neglectful of rules and care, it doesn’t. Websites are not up-to-date. Nursing facility conglomerates just change ownership stakes, re-brand their product and start again with a new name and no oversight. Or, they put a straw-man in place, someone who is seemingly the owner, but in reality, is not.  The entire system is a breeding ground for greed, indifference, dereliction of duty, fraud and neglect. When it comes to the care of the elderly and patients requiring rehabilitation, the families don’t complain because they are vulnerable, they need help and most don’t know to whom to turn. The result is a pattern of victimization, victimizing patients, families and even healthcare providers.

And, Medicaid and Medicare do nothing to stop the fraud that drains their coffers. And the industry itself couldn’t give a tinker’s damn about the injury that patients sustain as a result of profit over care.

Fraud, abuse and neglect is rampant. Look no further than recent news article, some of which we have listed below. Bad actors would rather file suit for defamation than deal with the problems. Denial works wonders, particularly if it is played out in court by those with deep pockets against those with fewer financial resources. 

As an example and one that we were alerted to a few months back, a patient in a nursing facility is charged for services he or she did not receive and should have. The first crime is charging for those services not provided.  It is a fraud perpetrated on the patient and upon the healthcare system as a whole. We all suffer for it. The second crime is not providing the services at all. That second crime is worse than the first, insofar as it reflects an indifference to the health and well being of the person entitled to that service. The third crime is that of those who are supposed to be overseeing the system. No one bothers to contact patients to ask if they are receiving care. All are guilty, no one is accountable and everyone suffers.

Another scenario so common it borders on unfathomable, a specialized nursing facility is habitually short-staffed and lacks sufficient specialized skilled nursing to recognize if a patient has a bladder infection, for example. The patient sits in pain, urinates uncontrollably and is often forced to sit for hours in his or her own urine. The lack of skilled nursing is a dereliction of the requirements of a skilled nursing facility. It is also a form of neglect and if the nursing facility is billing on those services, it is also a fraud. The pain faced by the patient is a form of abuse and sitting in one’s own urine is inhumane, at best, and utterly criminal at worst – cruel and unusual punishment.

These types of nursing facilities are rated under a system proposed by the government, one that is supposed to provide guidance to families. And yet it is an abject failure. There is no oversight. The money is lost from the system and basically handed to the nursing facilities to help owners and managers line their pockets, and line them they do. 

Another example, closer to home, an incapacitated stroke patient lies on his or her back for 10-12 hours at a time unless periodically moved, which requires assistance. Alternatively, the patient will and does develop bedsores. The nursing facility is short staffed and does not have the manpower required to watch over patients requiring this level of care. If that patient’s position is not changed regularly those bedsores can ulcerate, can get infected, can cause sepsis. They are painful, excruciating and thousands of patients in beds in nursing and rehabilitation facilities throughout the United States suffer because the personnel required to make sure these virtually immobile patients are getting their care costs money and requires compassion. The nursing and rehabilitation facilities do not want to hire additional nursing or support staff. It costs money taken from their exquisitely padded pockets. And compassion is sorely lacking, non-existent and when the scales are weighted between money and compassion, compassion is not a tipping point.

What is not emphasized in an overall analysis of our healthcare system is that hiring someone to constantly change a patient’s position is less expensive to the entire system then the cost of paying for sepsis. But in the ultimately financial analysis, the nursing and rehabilitation facilities do not get rewarded when they help patients to leave. They get rewarded when beds are filled, even if they are filed with patients who might be healthy enough to go home. In fact, the application for new homes requires that potential owners have a plan for keeping their nursing facility full. The system is utterly broken. Nursing home owners profit from money that comes from lengthened and prolonged stays within their facility. There is absolutely no motivation to help people. There IS MOTIVATION TO KEEP THEM SUFFERING.

Looking to the codes used for billing, sepsis can be charged to by a hospital or facility for treatment purposes. In other words, it is a “billable event.” Moving a patient to help prevent bedsores cannot be billed. The former is profitable and the latter is not. Owners of these nursing homes are not incentivized to keep patients comfortable and healthy, improve their quality of life. That requires “compassionate care” and few nursing homes have the moral and ethical wherewithal to even make that a consideration in their ownership and management of their facilities.  Simply put, they do not want to spend the money, they want the profit and the system feeds into fraud and abuse.

The Jewish community can claim ownership of a significant percentage of beds in the greater US nursing home arena [www.briuswatch.org] . This is a fact. Most large nursing and rehabilitation groups are Jewish run and Jewish owned [https://data.medicare.gov/widgets/y2hd-n93e]. How are we not shaming our own into treating the elderly with respect, dignity and a quality of care that reflects a level of humanity, compassionate and empathy commensurate with a decent Jewish soul? A level of care that reflects and overall basis in human dignity? How are we allowing our fellow Jews to utterly demoralize the elderly for personal gain?

The ultra-Orthodox, fighting for better conditions in jails were able to raise millions in a 72 hour period.  However, they look the other way when their friends and neighbors, their fellow synagogue members, wealthy nursing home owners defraud the system and abuse patients. Why is fighting for better healthcare oversight not as important, if not more so, then prison reform? The criminal element gets more attention than the elderly, those who spent years looking after us and are then neglected.

In reality, in most cases the inmates in US prisons are treated better than the elderly in US nursing and rehabilitation facilities. Perhaps when people get old and start to get sick, they should commit crimes. The reality in the US is that they would receive better care growing old, spending their golden years behind bars then they do subjected to nursing home treatment.

There are some crimes that many of us, those with a heart, compassion, empathy and a modicum of humanity find to be absolutely unthinkable. Among them is the rape of a child, the slaughter of people as they daven in synagogue or pray in other houses of worship and the blowing up of buildings by suicide as prime examples. There are so many others. Sources tell us that sexual predators and rapists have the worst reputations going into jails and prisons and are treated accordingly. Why are those who abuse the elderly not equally as worthy of our collective revulsion?

When we hear about crimes committed in Nursing/Physical Rehabilitation homes, why are we not equally as transfixed by the sheer weight of the depravity of the crime? How is the population not so moved as to lose sleep over what is happening to our elderly in nursing care? How can substandard care in nursing facilities be ignored? Have we as a society just accepted, with some form of cognitive dissonance, that this is simply the state of affairs? And don’t the members of the Jewish community who trade regularly in the nursing home business owe their patient class some level of humanity?

Federal and state websites, which are supposed to update the quality of nursing and rehabilitation facilities are not updated regularly, though they profess to be.[https://nursinghomereport.org/ownername-joseph-schwartz/ ] There is often little follow-up on complaints of neglect, abuse and fraud. The “grading system” is inconsistent throughout the different US states and is subjective. And, it is not uncommon to find repeat offenders given license to continue to purchase additional homes to add to their portfolio of nursing homes. It is both pathetic and almost laughable.

[https://data.medicare.gov/widgets/y2hd-n93e]

How can we as a civilized society accept this outcome? How can we be looking the other way? How can social workers in hospitals around the country be sending patients from their hospitals to substandard conditions in nursing and rehabilitation facilities? What is the duty of care of these social workers? And what obligation does the US healthcare, Medicare and Medicaid systems have to protect those within our society who are being harmed by nothing more than depraved indifference.

 

ADDITIONAL READING:

Whether Worth Less or Worthless, Quality of Care Issues Under the FCA are Worth Noting

WHERE IS THE OVERSIGHT?

SICK, DYING AND RAPED IN AMERICA’S NURSING HOMES

How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

Nursing home care: A growing crisis for an aging America

Questions Remain About Pennsylvania’s Vetting of Skyline Healthcare

Elder Abuse in Residential Long-Term Care Settings: What Is Known and What Information Is Needed?

Esformes will appeal convictions on 20 charges in $1.3 billion healthcare fraud case

Nursing Homes Held by Skyline Owner Face Crisis, Bouncing Paychecks in Mass.

Ex-independent living home employee found guilty of elder abuse

It’s a scheme’: Nursing homes owe thousands to Fall River pharmacy

Federal Way woman must repay state in workers’ comp scam

Nursing Home Abuse Statistics

The statistics reflecting incidents of abuse involving elderly residents in nursing homes and care facilities are both staggering and disheartening. At the broadest level, more than two (2) million cases of elder abuse are reported every year, and almost one (1) out of every ten (10) elderly individuals will experience some form of elder abuse. Moreover, virtually all parties working closely with the elderly on topics such as nursing home abuse have noted that the overwhelming majority of abuse incidents remain unreported. Sadly, while those figures reflect a national epidemic of violating the vulnerable, but also, most likely grossly understate the problem of elder abuse in the United States.

 

 

 

Esformes and Multi-Billion Dollar Fraud Yields Mixed Results from Federal Jury – [Law360]

Feds Get Mixed Results In Esformes Forfeiture Bid

Law360, Miami (April 9, 2019, 8:28 PM EDT) — A federal jury found Tuesday that nursing home mogul Philip Esformes should forfeit his interests in the operating companies for seven Miami-area facilities after his conviction for money laundering, but didn’t give the government most of the assets it sought.

Esformes’ counsel Roy Black of Black Srebnick Kornspan & Stumpf PA said the outcome exceeded the defense’s expectations, as the government effectively came away with only the operating licenses for the facilities but none of the various physical assets it sought, including money in various bank accounts and Esformes’ interests in the businesses’ real estate and several personal properties.

“Definitely, we did far better than we thought we would based on the counts of conviction,” Black told Law360.

The jury’s ruling in this second phase of the case continued a streak of mixed results for the government, despite prosecutors securing a significant conviction overall. The jury found Esformes, 50, guilty Friday on 20 counts of paying and receiving kickbacks, money laundering, bribery, and obstruction of justice at the end of a two-month criminal trial, but the convictions lacked any substantive health care fraud charges, even after the government consistently billed the case as the largest health care fraud case in history.

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Esformes Convicted – New York’s Versions of Esformes Need to be Prosecuted – Tish James Are you In?

Money, gavel

‘Parasite’ Esformes convicted in $1.3B nursing home fraud, could face remaining years in prison

Florida long-term care business mogul Philip Esformes faces the possibility of decades in prison after being convicted Friday in the largest healthcare fraud scheme ever charged by the U.S. Justice Department.

A 12-person jury deliberated for four days last week before agreeing that the 50-year-old entrepreneur was guilty on 20 out of 26 charges. Those include paying and receiving kickbacks, money laundering and conspiracy to commit federal program bribery. Jurors did not, however, reach a verdict on the main count — that Esformes conspired to defraud Medicare.

Prosecutors blasted Esformes following the conclusion of the eight-week trial for the $1.3 billion scheme to defraud both Medicare and Medicaid, calling him a “despicable,” “vampire” who was fueled by “unbounded greed.”

“Even beyond the vital dollars lost … Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes,” Shimon Richmond, special agent in charge of the U.S. Department of Health and Human Services Office of Inspector General’s Miami Regional Office, said in a statement. “We will continue the fight against such parasites.”

Sentencing has not been scheduled yet, but according to past reports, if convicted, Esformes could stand to face decades in prison.

He was first arrested in July 2016 and has been held without bond since. He could spend the rest of his life in prison, even without a healthcare fraud conspiracy, the Miami Herald said Friday.

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Nursing Home Owners Should be Under Greater Scrutiny: Philip Esformes and His 1.5M Ferrari are Not Alone in a Class of Master Manipulators of the System

Medicare Funds Traced To $1.6M Ferrari In Esformes Trial

Law360, Miami (March 13, 2019, 11:41 PM EDT) — A forensic accountant testified Wednesday at the health care fraud trial of Philip Esformes how he traced Medicare and Medicaid funds through the Miami businessman’s nursing facility network to payments for…
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ADDITIONAL READING:

US v Philip Esformes – Healthcare Fraud Trial of the Century

Philip Esformes is the poster boy in the biggest Medicare fraud trial in history. Prosecutors say he is the mastermind of a $1 billion fraud scheme. His trial, which began earlier this month, is one for the books. The evidence thus far can only be described as wild. Miami Vice meets the Sopranos.

In this post, we will pull back the curtain and demonstrate how ordinary healthcare workers and patients can take down a Goliath.

Until his arrest in 2016, Esformes was the ultimate jetsetter. Private jets, luxury mansions and a lifestyle none of us can afford. If prosecutors are right, however, we certainly paid for his high living.

According to the indictment, Esformes owned many Miami area nursing homes and assisted living facilities. Much of his revenues came from Medicare and Medicaid. Those programs, of course, are funded with tax dollars.

The government says Esformes gave kickbacks to physicians in return for medically unnecessary referrals to his facilities. That means he was bribing doctors to admit patients into his nursing homes even if they didn’t need that level of care.

The bribes were a two way street.

Prosecutors say that Esformes accepted bribes from other healthcare providers interested in getting business from his nursing homes. These included bribes from nursing companies, home care services, labs, vision care and therapy providers. Some bribes were in cash while others were allegedly payments to escorts enjoyed by Esformes.

One of Esformes’ co-conspirators is a physician’s assistant who would sometimes sign nursing home referrals without even meeting the patient.

It seems everyone was raking in the dough, even if the patients weren’t benefitting and with no regard to the taxpayers footing the bill.

As the trial started, all of Esformes’ co-conspirators pleaded guilty. That leaves him fighting the charges alone.

Most of the charges against Esformes are criminal conspiracy, wire fraud and Medicare fraud related.

There is also a charge of obstruction of justice. The indictment says that in 2015, he plotted with two brothers to get one out of the United States. The brothers were potential prosecution witnesses in the case. Unbeknownst to Esformes, the brothers were already cooperating with the feds and recorded a call discussing the scheme.

Shocking Evidence Revealed at Trial

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Philip Esformes, Nursing Homes and U Penn Basketball Bribes, a Pillar of the Jewish Community

Former Penn basketball coach says he received $300K bribe

Former University of Pennsylvania basketball coach Jerome Allen – now a coach with the Boston Celtics – testified during a federal criminal trial that he accepted nearly $300,000 in bribes to use a priority varsity sports slot to accept a businessman’s son into the Philadelphia Ivy League school, multiple media outlets are reporting.

Allen was testifying in a case involving Philip Esformes, a Miami nursing home mogul on trial for alleged Medicare and Medicaid fraud.

Here’s what ESPN.com is reporting:

Allen testified that he trained Esformes’ son, Morris, in basketball during several trips to Miami, in which Esformes paid for Allen to stay in beachfront hotels, ride in limousines and attend Miami Heat games. After the workouts, Esformes handed him plastic bags filled with about $10,000 in cash, Allen told the jury, according to Law360.com. Esformes told Allen his son’s dream was to attend Penn and play basketball for the Quakers. If Allen made that happen, Esformes told him, they would be “family for life.”

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Philip Esformes, Claims that Patients Sold Like Cattle, but… Esformes is Not Alone in Nursing and Healthcare Facilities and the Fraud they Commit