Esformes Must Forfeit Interests in Long-Term Care Companies, if Only Others Would Follow

Esformes must forfeit interest in long-term care operating companies, judge rules

Philip Esformes, the Florida assisted living and skilled nursing facility owner found guilty in April of more than 20 charges in a case that the federal government described as “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” must forfeit his interest in seven operating companies related to his facilities, a federal court has ruled.

The decision, issued July 1 in the U.S. District Court for the Southern District of Florida, was a denial of Esformes’ motion asking the court to acquit a jury’s verdict that the assets were forfeitable. The judge’s order applies to Esformes’ interest in the operating companies for the following assisted living or skilled nursing properties: Eden Gardens in Miami, Fair Havens Center in Miami Springs, Flamingo Park Manor in Hialeah, Harmony Health Center in Kendall, North Dade Nursing and Rehabilitation Center in North Miami, Nursing Center at Mercy in Miami and the now-closed Oceanside Extended Care Center in Miami Beach.

“Esformes’s operating companies gave his business a facade of legitimacy as he used them to hold bank accounts and operate the various SNFs and ALFs engaged in the elaborate money laundering and kickback scheme,” U.S. District Judge Robert N. Scola Hr, wrote. “Accordingly, the Court finds that there is sufficient evidence to ‘permit a reasonable jury to conclude that the Government has proven, by a preponderance of the evidence, that the property is subject to forfeiture.’ ”

Scola also denied Esformes’ motions seeking acquittal and a new trial.

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Skyline’s Wreckage, The US Healthcare Travesty – Help Wanted – Frank Romano Taking Care of Skyline’s Patients

Losing money and struggling to find workers, a nursing home operator feels the squeeze

Nursing assistant Rachael Moreau (right) helped resident Katherine Lapre at Brandon Woods home in Dartmouth.
Nursing assistant Rachael Moreau (right) helped resident Katherine Lapre at Brandon Woods home in Dartmouth.(JONATHAN WIGGS/GLOBE STAFF)

DARTMOUTH — When five Skyline nursing homes shut their doors last month, Frank Romano came to the rescue. He accepted more than three dozen old and frail residents at a pair of nursing homes he owns here and in neighboring New Bedford.

Now he’s scrambling to find nurses to care for them, along with more kitchen, laundry, and maintenance workers. As he looks for help, he’s struggling to operate the properties profitably in a Massachusetts long-term care sector that’s been losing money for years.

“They’re human beings, and I want to do the right thing,” said Romano, 76, chief executive of Essex Group Management, which owns six nursing homes and two assisted living residences. “But for every Skyline resident I took in, I’m losing $37 a day.”

Romano’s homes boast distinctive features — a Japanese koi pond and red British phone booth brighten the grounds of his Brandon Woods home here — but they face the same financial squeeze that’s weakened most of the state’s remaining 386 skilled nursing facilities.

Thirty nursing homes have shuttered in the past 18 months — and 214 since 2000 — a little noticed 35 percent shrinkage that has uprooted many of the state’s most vulnerable residents.

After a state court appointed a receiver to manage the shutdown of the five South Coast homes operated by Skyline Healthcare, residents were moved with little notice — or choice about their destination.

“They said, ‘We’re closing up shop and you’re going,’” recounted John Pine, 88, one of about 15 residents sent to Brandon Woods in Dartmouth. “Some went here, some went somewhere else. . . . They just put you where they want.”

In all, 245 residents were displaced from the five Skyline nursing homes in New Bedford, Fall River, and Dighton after their New Jersey-based operator surrendered its licenses earlier in the spring. Many of their residents are disabled or suffer from dementia, and most need help with daily activities such as getting out of bed, eating, and using the toilet.

The circumstances behind the Skyline closings are under investigation by the state attorney general. A pending lawsuit by the state of Florida accuses the company of deducting money from employee paychecks for insurance that wasn’t provided. Former employees and operators who took over Skyline homes in other states have said the company bounced checks.

John Pine recently was relocated to Brandon Woods home in Dartmouth, where he was assisted by unit manager Christine Cabral.
John Pine recently was relocated to Brandon Woods home in Dartmouth, where he was assisted by unit manager Christine Cabral.(JONATHAN WIGGS/GLOBE STAFF)

Its unraveling was only the latest setback for the Massachusetts nursing home industry.

Romano, a gregarious businessman who greets many of the residents and employees of his homes by name, can tick off the pressures facing operators.

They’ve gotten only small payment adjustments from MassHealth, the state Medicaid program that covers two-thirds of nursing home residents. The adjustments don’t keep pace with rising labor costs and expenses such as utilities and real estate taxes.

At the same time, employers such as Amazon, which opened a massive warehouse in Fall River two years ago, woo nursing home workers with slightly higher wages.

Romano said he can’t find enough workers to staff his properties here or in Tewksbury, Milford, and Worcester. It’s especially tough to recruit certified nursing assistants. He offers base pay of $15 an hour — plus a differential for evening and overnight shifts, along with overtime and bonuses to cover weekend shifts — but still finds it hard to compete with Amazon, which a spokeswoman said pays warehouse workers as much as $18.25 an hour.

“They’re offering higher wages, he said. “That’s where people are going.”

New federal restrictions on immigrants, who make up about 40 percent of nursing home employees, further aggravate the crisis. Early next year, the US government is set to end temporary protected status granted to Haitians who came here to work after the country’s 2010 earthquake. That means Haitian nursing home workers, including those at Romano’s homes, will be forced to return to the island.

“These are the workers who never call in sick or come in late,” said Tara Gregorio, president of the Massachusetts Senior Care Association, a Waltham-based trade group for the state’s nursing home operators. “These are the workers we can least afford to lose.”

Nursing home operator Frank Romano is having a hard time finding employees.
Nursing home operator Frank Romano is having a hard time finding employees.(JONATHAN WIGGS/GLOBE STAFF)

Romano said he has taken out advertisements seeking American citizens to work at some of the jobs being vacated. “None of them even want to apply,” he said.

In response, Romano sought and received permission from Puerto Rico, a US territory, to bring 150 workers to his Massachusetts properties over the next year. They include nurses, nurse assistants, personal care aides, housekeepers, and mechanics. But to make sure they can afford to live in a high-cost state, he’ll also have to provide housing for them.

He’s counting on the state government to boost MassHealth reimbursements for nursing home residents, which would in turn increase his revenue. State lawmakers have recommended modest payment increases for the coming fiscal year, but thus far the Baker administration has budgeted no new funding.

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Health Headlines of King and Spalding – OIG and Nursing Home Results, Prevalence of Abuse and Reporting Issues

OIG Releases Audit Reports Finding High Prevalence of Nursing Home Abuse, Deficient Reporting Mechanisms

On June 12, 2019, OIG released two audit reports, A-01-17-00513 and A-01-16-00509, as part of its efforts to improve identification, reporting, and investigation of potential abuse and neglect of Medicare beneficiaries. OIG’s audits were prompted in part by investigations showing “a significant number of Medicare claims submitted for the treatment of injuries related to potential abuse and neglect.” OIG found that incidents of abuse and neglect in skilled nursing facilities (SNFs) were not sufficiently tracked, reported, and investigated, and that Medicare’s diagnosis code data could help point to abuse and neglect. The audit reports follow CMS’s recent release of its five-part nursing home plan focused on improving nursing home quality.

In OIG Report A-01-17-00513, titled, “CMS Could Use Medicare Data to Identify Instances of Potential Abuse or Neglect,” OIG identified nearly 35,000 Medicare inpatient and outpatient claims (totaling approximately $100 million worth of services) from 2015 to 2017 containing one of 17 diagnosis codes that may correlate to abuse or neglect, such as potential sexual abuse or nutritional neglect. Of that group, 100 claims underwent an in-depth review.

OIG found that 94 of the 100 claims evidenced potential abuse or neglect; among them, 61 were likely associated with incidents in the beneficiaries’ home and 16 incidents occurred at others’ homes or in public settings like parks and alleys. From this 100-claim data sample, OIG estimated that 89% of the nearly 35,000 cases had underlying medical records evidencing potential abuse or neglect. OIG further estimated that 8% of those cases may have been perpetrated by a healthcare worker, among other findings.

OIG recommended that CMS “compile a complete list of diagnosis codes that indicate potential physical or sexual abuse and neglect,” “conduct periodic data extracts” of Medicare claims with one of those codes, “inform States that the extracted Medicare claims data are available to help States ensure compliance with their mandatory reporting,” and “assess the sufficiency of existing Federal requirements . . . to report suspected abuse and neglect of Medicare beneficiaries . . . .” CMS disagreed that the recommended claims data would timely assist it with addressing acute problems, but OIG “continue[d] to recommend the use of the Medicare claims data” to thwart abuse and neglect.

In OIG Report A-01-16-00509, titled, “Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated,” OIG reviewed a set of claims of Medicare beneficiaries residing in SNFs who had emergency room visits in 2016 that resulted in one of 580 “high-risk” diagnosis codes, and whether the SNFs reported those potential instances of abuse or neglect. The audit also focused on the adequacy of CMS’s reporting and tracking of those potential instances of abuse and neglect.

Specifically, OIG pulled a sample of 256 emergency room (ER) cases from over 37,000 high-risk hospital ER claims for nearly 35,000 Medicare beneficiaries residing in SNFs in eight states in 2016. OIG worked with the State Survey Agencies (SSAs) to review the underlying medical records to determine whether the ER cases were the result of abuse or neglect in the SNF. OIG concluded that approximately one in five of the ER claims were the result of abuse or neglect. OIG also found that the SNFs “failed to report many of these incidents” to SSAs, meaning the SSAs could not conduct immediate onsite investigations. The SSAs themselves also, given the opportunity, “failed to report some findings of substantiated abuse to local law enforcement.” OIG also faulted CMS’s recording and tracking mechanisms for failing to capture all fraud and abuse incidents.

OIG recommended that CMS “take action” to ensure that such incidents are properly identified and reported by improving training for SNF staff and requiring SSAs to track all incidents and subsequent referrals to law enforcement. CMS concurred with these recommendations.

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FIGHTING BACK! Pt. 4 – State Oversight of Nursing Facilities, Do Changes in Leadership Mean Changes in Ownership?

Tioga nursing home responds to critical report

PINEVILLE, La. (KALB) – A Tioga nursing home is one of five in the state put on a list for possible increased government surveillance due to quality concerns.

Tioga Community Care Center off of Shreveport Hwy. in Tioga. | Photo Source: KALB

The Advocate reported on Tuesday that Tioga Community Care Center is on that list. The list was put out by the Centers for Medicare and Medicaid Services for nursing homes. It identifies those that fail to meet certain health and safety standards. CMS is governed by the U.S. Department of Health and Human Services.

That means the Tioga Community Care Center could see more frequent inspections. And, if a facility fails to implement changes, they could lose government funding. The list got traction after two U.S. Senators asked for the information from CMS.

Tioga Community Care was added to the list after a December 2018 report said some residents were put in “immediate jeopardy” after one lost 26 pounds in nearly four months and was down to 79 pounds — and that a registered dietician recommended treatment, but it was never implemented.

Tioga community care center did email KALB and said they’re making changes. They said they’ve changed leadership and survey standards. As well as adding more corporate support, education, and monitoring.

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FIGHTING BACK! Pt. 3 – Otswego, NY Nursing Home Families and Members – Report Abuse, Neglect and Safety Standards

NY knew for years about Oswego nursing home’s leaky roof, but didn’t get action


OSWEGO, N.Y. — A state agency responsible for safeguarding nursing home residents knew for years the roof of an Oswego nursing home was leaking water into residents’ rooms, but did not make the facility fix the problem.

The roof finally got repaired when the City of Oswego threatened to shut down the 80-bed Pontiac Nursing Home in March after a resident complained to the city’s code enforcement department. A city inspector found an elaborate jerry-rigged system of hoses and buckets collecting water leaks affecting about 20 residents. In some rooms, hoses running down from ceilings were wrapped around electrical outlets then threaded out windows.

The roof had been leaking for seven years, Post-Standard revealed in a story last week.

The state Health Department is supposed to inspect every nursing home at least once every 16 months and make homes correct deficiencies.

But an advocate for nursing home residents said the situation at Pontiac Nursing Home shows the Health Department is not aggressive enough.

Richard Mollot of the Long Term Care Community Coalition, a group based in Manhattan, criticized the health department for not slapping Pontiac with financial penalties in recent years to get it to fix the roof. “If you have citations and there is no penalty associated with them, then you are telling the facility, ‘This is OK,’” Mollot said. review of Pontiac Nursing Home inspection reports show Health Department inspectors discovered water-stained ceiling tiles and a hose running down from the ceiling of a resident’s room into a rusty bucket in 2015 and 2016.

During the 2015 inspection the nursing home’s maintenance director said the stained ceiling tile was from a roof leak. He said he couldn’t remember when it happened. In a plan of correction approved by the Health Department, the nursing home said it fixed the ceiling tiles, but made no mention of repairing the roof.

In a 2016 inspection report, the maintenance director said the rusty bucket and hose in Room 216 were used temporarily to capture water from a leak that had been fixed three months earlier.

But the ceiling in that same room was still leaking earlier this year when the Health Department returned March 7 to do another inspection after getting a complaint from the Oswego code enforcement department. During that visit, the maintenance director told the inspector “ … he had been telling the owner of the building it needed a new roof for 7 years, and for 7 years he had been applying band aids to the leaks.”

When asked twice why it did not make Pontiac repair the roof before the Oswego code enforcement department had to step in, the Health Department dodged the question.

“The Department has cited the Pontiac Nursing Home for multiple maintenance and housekeeping issues, which the facility subsequently addressed,” it said in a prepared statement.

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FIGHTING BACK – Pt. 2 – Nursing Home Patients and Their Families, Victims of Abuse, Report and Seek Counsel Representing Victims

Aurora nursing home sued again after resident beats wheelchair-bound 92-year-old woman

Jury awarded other plaintiff beaten by same resident $3.6 million

An Aurora nursing home is being sued for a second time over allegations that a resident with a history of violence continues to injure other residents and that the facility does not have enough staff to properly care for the Alzheimer’s and dementia patients who live there.

The lawsuit filed last week in Arapahoe County District Court accuses Renew Saddle Rock of putting its financial goals over residents’ safety by under-staffing the home.

In October, an Arapahoe County jury awarded a former resident a $3.6 million verdict after he was beaten by a fellow resident, who has been identified as “Anne B.” Two months after the verdict, the nursing home owners changed the facility’s name to Renew Saddle Rock from Peregrine Senior Living at Aurora, the lawsuit said.

The new lawsuit was filed by Denver attorneys Jerome Reinan, Jordana Gingrass and Beth Dombroski on behalf of Joanna Dryva, whose mother, Maria Pallman, was injured in the attack. Dryva is seeking more than $100,000 in damages against Renew and the nursing home’s corporate owners, First Phoenix-Aurora of Wisconsin and Peregrine Management of Colorado.

The latest lawsuit accuses Anne B. of pummeling Pallman, a 92-year-old, wheelchair-bound woman who also suffers from dementia. On May 29, Anne B. hit Pallman in the face as she sat in a wheelchair in a hallway, the lawsuit said. Pallman now suffers from anxiety, and recurring headaches that she didn’t have before the assault, the lawsuit said.

The nursing home has refused to turn over surveillance footage of the assault, it said.

RELATED: These Colorado nursing homes were poorly rated and eligible for federal oversight. Until this week, nobody knew.

Attempts to reach the director of Renew and the facility’s owners were unsuccessful.

The lawsuit also accuses former nursing director, Britny Otto, of violating state law when she denied that Anne B. had assaulted a staff member during testimony about the first lawsuit.

“Despite actual knowledge that it was understaffed, Otto and Peregrine aggressively marketed Peregrine as having higher staffing than its competitors, as well as a better activities program than its competitors,” the lawsuit said. Otto had failed to report Anne B.’s assault on a staff member to police or the Colorado Department of Public Health and Environment as required by Colorado law, the lawsuit said.

Renew Saddle Rock’s website said the memory care facility offers “all of the services and amenities that provide residents and families complete peace of mind, while transcending the status quo with experiential innovations like custom jewelry design and woodworking with local artists or private concerts with wine and cheese pairings.”

Peregrine actually staffed the nursing home with only one worker for up to 28 dementia patients during night shifts and on weekends, the lawsuit said.

Dryva would not have admitted her mother to the nursing home if she had been told about the first assault and the fact that Anne B. was still living in the home, the lawsuit said.

Anne B. has also been accused of assaulting a third Renew resident, who was identified as “Josephine,” and a worker who quit because of the attack, the lawsuit said. The nursing home did not report the assaults to law enforcement or licensing authorities, the lawsuit said.

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FIGHTING BACK! VictimS of Nursing Home Abuse and Neglect, Make it Public and File Suit Against Owners [video]

Making the Case | The rights of nursing home residents and families

Unfortunately, nursing home abuse is all too common, and many cases go unreported.

However, there are standards of care that nursing homes must meet. If they fail to meet these standards, victims and their families can sue in civil court.

Nursing home abuse can involve intentional physical violence, sexual assault, psychological abuse, financial exploitation, and neglect. While some forms of abuse are obvious, others are harder to detect.

Signs of nursing home abuse or neglect may include:

Broken bones, bruising or cuts

Frequent infections


Mood swings and emotional outbursts

Refusal to eat or take medications Or

Unexplained weight loss

If you believe your loved one has been abused or neglected by a nursing home or assisted living facility, visit