A significant number of nursing home residents are shorter-term residents who are recuperating from surgery or illness. A recent study centered on the information provided when patients are discharged from hospitals to nursing homes, and they or their families are tasked with choosing a post-acute care facility.

As a result of regulations and incentives imposed by the Affordable Care Act, hospitals began being held partly accountable for Medicare patients’ care after discharge. However, little information has been available about the process of patients choosing a post-acute care facility.

Continue Reading Patients Often Discharged to Nursing Homes with No Information on Quality of Care

How does the role of an MDS Coordinator relate to patient care and Medicare or Medicaid fraud?

A nursing home MDS Coordinator assesses the capabilities of a patient and creates individual care plans—including the level of treatment that must be delivered. A person in this position may be doing their job right but then fall under the pressure from the nursing home to up the ante for more billings or risk losing a well-paying job. It starts out with a fudged physical therapy session here or there. Then the message flows downhill to CNAs and other healthcare staff resulting in more falsified records. This escalates with more and more demands from above to get additional services—and higher value services—added to the bills. In the end, the Government is defrauded.

Continue Reading Rights of Whistleblowers: MDS Coordinators

The most recent attempt to overhaul the nation’s health care system would fundamentally alter Medicaid and jeopardize home and community-based services, according to www.DisabilityScoop.com. A chart outlining the proposed bill is available here.

After a prior Republican plan to repeal and replace the Affordable Care Act failed, this new effort in the U.S. Senate again seeks to upend the Obama-era law.

The proposal introduced last week by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wis. runs into a deadline of September 30. After that date, a simple majority will not suffice to pass the measure – rather, 60 votes would be needed to do so.

Thus, Republicans have until Sept. 30 to repeal Obamacare with only 51 votes in the Senate under the current budget resolution.

Continue Reading New Healthcare Bill Would Impact Medicaid Services

Mandatory Arbitration in Nursing Home Admission Contracts

A proposed rule change introduced by the Trump administration would authorize mandatory, pre-dispute arbitration in long-term care admissions contracts. The proposed rule is in response to an Obama administration rule that prohibited federal funding for long-term care facilities that required residents to resolve disputes through arbitration.

ABA Writes Letter Opposing Rule Change

In a recent letter, the American Bar Association (ABA) advocates for the Centers for Medicare and Medicaid Services (CMS) to retain its current rule prohibiting long-term care facilities from entering into binding arbitration agreements with residents until after a dispute arises. In the letter sent to CMS administrator Seema Verma, the ABA writes that implementing the proposed rule would harm residents’ rights and interests.

Continue Reading ABA Resists Mandatory Arbitration Clauses in Nursing Home Admissions Contracts

When a loved one moves into a nursing home, staff members have a duty to continually provide the resident with the appropriate level of nursing care, medical care and personal attention.

Nursing home staff members are responsible for the residents’ well-being and are required to report all signs of abuse or neglect, including those arising from resident-to-resident interactions.

One form of abuse or neglect that may be overlooked by staff members is senior bullying. Continue Reading Is My Elderly Parent Being Bullied?

To increase protection of its elderly and disabled citizens from abuse and neglect, the state of New Jersey is expanding its Safe Care Cam program to nursing homes, residences for the developmentally disabled, and other institutional care facilities. The Safe Care Cam program loans free surveillance cameras to New Jersey residents to monitor the treatment provided by caregivers. The cameras are provided for free 30-day loans to families who suspect or question whether a care provider is abusing or neglecting their loved one.

Continue Reading New Jersey’s Safe Care Cam Program Expanded to Nursing Homes

Without a hearing, our new congress wasted no time in trying to severely limit damages in nursing home abuse claims. A newly proposed law called the Protecting Access to Care Act of 2017 H.R. 1215, seeks to limit non-economic damages in all medical cases to $250K for everyone in the country.

Continue Reading New Congress Trying to Protect Corporations from Nursing Home Abuse Claims

In its five-part “Failing the Frail” series, a PennLive investigation reveals the 18 most understaffed Pennsylvania nursing homes. The series includes an interactive map to search for staffing levels of individual nursing homes.

Based on PennLive’s analysis of 559 facilities, nursing homes in Pennsylvania provided residents with an average of only 3.6 hours of care per day, well below the minimum 4.1 hours recommended for safe care, although within Pennsylvania’s minimum staffing requirement of 2.7 hours of care per day. The analysis found 477 homes, or 85 percent, provided less than the recommended level. The analysis further found that 183 homes, or 33 percent, were dangerously understaffed because they provided less than 3.5 hours of care per day and, less than 32 minutes of care from registered nurses.

Continue Reading Pennsylvania Nursing Homes Often Understaffed

During much of the 20th century, hospitals did not have a duty to treat patients who entered emergency departments. Without any given reason, they could refuse to treat certain patients. The practice of “patient dumping” arose from that lack of duty.

Patient dumping refers to situations when hospitals deny emergency medical screening and stabilization services. It also refers to instances when a hospital transfers an individual to another hospital after discovering that the individual does not have insurance or a means to pay for treatment.

To correct that wrong and in an effort to ensure that individuals received needed emergency care, in 1986 Congress enacted EMTALA, which was designed to protect all individuals seeking evaluation or treatment at hospital emergency departments that participate in Medicare. Continue Reading Patient Dumping and the Emergency Medical Treatment and Labor Act (EMTALA)

According to Medicare fraud reports by the U.S. Department of Human Health and Services (HHS), the U.S. Department of Justice’s Medicare Fraud Strike Force team has investigated $7 billion in fraudulent billing since 2007 and prosecuted over 2400 medical professionals and administrators. Part of that amount comes from nursing homes that bill for unnecessary services or for services that have not been provided to the residents that depend on them.

And that fraudulent activity harms nursing home residents as well as our government’s bottom line.

Continue Reading How Nursing Home Staff Can Help Prevent Medicare Fraud