Law360 (April 3, 2019, 10:11 PM EDT) — A New York law firm did not violate federal debt collection laws or state deceptive practices laws when it sued a man for $50,000 owed to a nursing home, but it’s too soon to say whether it ran afoul of a legal ethics statute, a federal judge ruled Wednesday.
U.S. District Judge Denis R. Hurley said plaintiff Eric Kravitz’s Fair Debt Collection Practices Act claim and his New York General Business Law claim against
UPDATED 10:44 pm 2.May.2019
Esformes is Not Alone – a New York Nursing Facility Unnamed and Likely Unconnected to Esformes but with the Same M.O.
Several months ago we received a call. It was from a woman caring for a family member in a nursing/rehabilitation center in New York. We were told that at the time her relative was admitted, the ownership was a well known and rather notorious facility group. The home had been flagged for numerous violations under the initial ownership, publicly available information. We did not write anything because we did not want the entanglements and could not at the time substantiate her claims.
By the time her relative left, we were told the home had changed hands and was owned by another group; and the care had significantly deteriorated. At some point during late 2018/early 2019 the facility changed hands. Those records, at least the ones that illustrate a uniquely questionable transfer, are available online. We have been told, and several articles have come out publicly that nursing homes will often just switch hands because under new ownership, the ratings available on the Medicare/Medicaid sites gets wiped clean, even though ownership may not completely change. It’s a strategic misrepresentation, a game, and apparently legal.
Our caller’s complaints when she first contacted us was that her relative was not getting the care charged to Medicaid. He was not getting the therapy charged and claimed. He was allegedly getting treatment and medication that was not actually being provided and the care he was supposed to get was nowhere to be found. She complained endlessly to the facility and elicited the assistance of the Department of Health and various NYS entities.
The facility would not release him to her care or discharge him. Each time she would be told her relative was being released, she would then be told that she was not getting discharge papers. The administration kept claiming something new was wrong with her relative, a new service was required, new forms of care were needed.
That service was never forthcoming, though Medicaid was charged.
She contacted us regularly both before and after the home changed hands and we have that information and photographs, a few of which support some of her claims. She also contacted the State and we have been told that they initially tried to assist; but as soon as the facility changed hands, the Department of Health refused further assistance. We wonder whether someone on the State level has been paid to keep this quiet to allow for this owner to continue to operate.
We will protect our caller’s confidentiality except as necessitated by law enforcement.
At one point her relative was sent to a hospital and was summarily returned to the facility after recovering from repeated bouts of pneumonia. We have been advised that the Social Worker at the hospital conveyed to her that they are told to continue sending people to the nursing home in question and others under the same ownership. Our caller has commented that she thinks people at the hospital are being incentivized to send people to these facilities. We cannot substantiate this part of the story yet. It would take someone with access to subpoenas to get those records.
It is, however, another reason why the facility and its ownership remains unnamed in this post.
We have been told, and this has been corroborated by a number of former patients at the same facility, that there is a pattern and practice of charging healthcare and medicaid exorbitant sums of money for treatment that is never supplied, for therapy that is never provided and for medications that are not actually doled out. The patients can get copies of their bills if they demand them (and some have) and they know when their loved ones are being denied services, or simply not offered those services.
There is much more.
From our own research we discovered a few red flags. The current ownership structure raises questions. The facility’s owners appear to be a group; but we have discovered that this particular nursing facility has a series of UCC liens on it in the State of New York from March of 2019 or thereabouts under the name of someone not listed on the official records of the State or available records as a “direct” owner. This is not quite kosher, unless the person listed on the UCC’s was granted rights to encumber the facility absent direct ownership or as an “indirect owner.” That seems odd. And what does that actually mean?
Why would anyone have the rights to encumber assets they do not own directly?
As to the condition of this facility, we would avoid it for even a fish tank, nonetheless the health of the elderly and most vulnerable within our community. We have been told beyond the litany of potentially questionable behaviors, the odd ownership structure and the seemingly financially incestuous relationship between the direct versus the indirect owners, the place is understaffed, dirty and the patients are not receiving even a modicum of the care required. We have further been advised that the food is inadequate, if edible, the sheets and linens are not cleaned regularly and bandages and other first aid measures are not properly attended to and it takes extreme measures to convince staff to have a patient sent to the hospital.
Our hope is that the owners who may or may not read this post, be well advised that we are following this story carefully. We are digging and will continue to dig. Should law enforcement want information we will gladly pass it on.
To the owners, may you one day wind up in your own nursing care facilities; and may you get no better than the worst care you provide your victims, and they are victims.
Esformes is not alone. Our elderly deserve better. The State of New York should be paying attention.
The federal government has updated its website used to rate nursing homes with new methodology that it says will better serve consumers, more accurately accounting for the facilities’ inspections, staffing and other measures.
While tinkering with the formula for its Nursing Home Compare website, the Centers for Medicare & Medicaid Services still uses a scale from one to five stars to rate more than 15,000 facilities. Nursing homes receive both an overall star rating and sub-ratings for how they stack up on their staffing levels; their performance on state health inspections; and a combined group of quality measures accounting for care issues such as the percentage of patients with pain, sores, incontinence and hospitalizations.
The new ratings posted Wednesday for 61 nursing homes in Allegheny County show eight facilities with five-star ratings, 21 receiving four stars, 20 with three stars, nine given two stars, and three with one star. Beyond the star system, a range of detailed information about different aspects of care — plus state inspection histories — is available by entering a facility’s name in the website’s search field.
The local five-star homes are Harmony Physical Rehabilitation in Monroeville, Little Sisters of the Poor in Brighton Heights, North Hills Health and Rehabilitation Center in Pine, Providence Point Healthcare Residence in Scott, UPMC Magee-Womens Hospital Transitional Unit, UPMC McKeesport Long Term Care Facility, Vincentian de Marillac in Stanton Heights, and West Hills Health and Rehabilitation Center in Moon.
The one-star facilities are Baldwin Health Center, Cheswick Rehabilitation and Wellness Center and the Corner View Nursing and Rehabilitation Center (formerly Forbes Center for Rehabilitation and Healthcare) in Larimer.
In many cases, the local nursing homes receiving the highest rating are smaller, nonprofit homes — with fewer than 75 beds — while the three one-star homes are all for-profit operations with at least 121 beds.
Allegheny County owns and operates four nursing homes in its Kane system. Its Glen Hazel and Scott facilities received three stars while the McKeesport and Ross operations have two stars.
The federal government created Nursing Home Compare in 2008 as a way to assist consumers in what can be a difficult decision-making process. Individuals and families often have little time to evaluate whatever facilities may be located near them or which may be suggested by a hospital social worker or other health care professional.
Industry officials raised concerns last week that the update to Nursing Home Compare could be confusing, as new methodology may have caused some facilities’ ratings to drop even though their levels of care and staffing may be same as before the update. The Pennsylvania Health Care Association, which represents many for-profit homes, reported that more than 30 percent of nursing homes in the state suddenly lost one or more stars.
“While the five-star system can be a helpful tool, families should not rely on it exclusively when choosing a nursing home for a loved one,” association president Zach Shamberg said.
Richard Mollot, executive director of the Long Term Care Community Coalition, a national consumer advocacy group, agreed that Nursing Home Compare should not be the only decision-making guide, because people would benefit from visiting homes for firsthand assessments of resident engagement, interactions with staff, dining, odors and other aspects.
But for objective data, Mr. Mollot said, Nursing Home Compare is better than any other source, and that the federal government has worked to fine-tune and improve the information over the years. Among recent changes, he said, are more reliable information about staffing levels and an inspection process that calls for surveyors to interact more with residents and observe operations rather than relying too much on paperwork and interviews with administrators.
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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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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.
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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“He was the mastermind, he made this happen,” Young said, according to the Herald. “He was the owner, operator of these facilities. He got the money from Medicare and Medicaid. He was involved in every step of the way.”
“He sold his own patients like cattle for money,” Young added later.
Two other key players in the effort — a former hospital leader and physician’s assistant — pled guilty for their roles last month, and could face years in prison. The trial is expected to last at least two months, with jurors set to hear from former nursing home residents and co-conspirators who are cooperating with the government.