DOJ Files False Claims Suit Against Nursing Homes Over “Substandard Services and Nonexistent” Care

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 15, 2022, the U.S. Department of Justice (DOJ) announced it has sued three nursing homes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” The False Claims Act (FCA) complaint against the American Health Foundation (AHF), its affiliate AHF Management Corporation, and three nursing homes alleges the facilities fraudulently billed the Centers for Medicare & Medicaid Services (CMS) for often “nonexistent care.”

According to the complaint, all three AHF nursing homes not only provided substandard nursing home care services that failed to meet required standards of care but also did not maintain adequate staffing levels between 2016 and 2018.

Click here to view the complaint filed by the DOJ in the U.S. District Court for the Eastern District of Pennsylvania.

FCA Violations For “Substandard or Nonexistent Care.”

The government alleged AHF Management and its entities violated the FCA stemming from reimbursements for “grossly substandard” care provided at the Cheltenham, Wilmington Place, and Samaritan nursing homes.

“The defendants knowingly submitted, or caused the submission of, false claims to Medicare and Medicaid for nursing home care and services that were blatantly substandard or nonexistent,” the complaint read. “The Medicare and Medicaid programs provided reimbursement for the claims, but these payments were by mistake as CMS didn’t know the true and full extent of the defendants’ failure to provide patients with proper treatment and care.”

Alleged Patient Conditions and Mistreatment.

Examples of the appalling conditions described in the complaint included housing elderly and medically vulnerable patients in “pest-infested” buildings whose belongings were often stolen; giving residents unnecessary medications, including antibiotic, anti-psychotic, anti-anxiety, and hypnotic drugs; subjecting residents to verbal abuse; neglecting to provide residents with activities or stimulation, and failing to provide needed psychiatric care.

Additionally, the complaint outlines the suicide of a resident who was admitted with a history of self-harm and was later hospitalized after slashing his wrists but still was not provided psychiatric services. Tragically, just weeks after readmission, the resident committed suicide by hanging himself from a bedsheet in a shower room, justice officials said.

“Nursing homes are expected to provide their residents, which include some of our most vulnerable individuals, with quality care and to treat them with dignity and respect,” said Assistant Attorney General Brian M. Boynton, head of the DOJ’s Civil Division in a statement. He continued, “the department will not tolerate nursing homes, or their owners or managing entities, who abdicate these responsibilities and seek taxpayer funds to which they are not entitled.”

To read the DOJ’s press release in full on the case, click here.

The United States’ complaint stems from an investigation that the DOJ initiated as part of its “National Nursing Home Initiative.” The department launched the initiative in March 2020 to identify and investigate nursing homes that provide grossly substandard care.

Click here to learn more about the Justice Department’s nursing home initiative.

The case is United States v. American Health Foundation Inc., case number 2:22-cv-02344, in the U.S. District Court for the Eastern District of Pennsylvania.

Contact Health Law Attorneys Experienced in Handling False Claims Act (FCA) Violations, Investigations, and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in defending audits and investigations by the Department of Health and Human Services, the Department of Justice, The Drug Enforcement Administration (DEA), the Florida Department of Health (DOH), Medicaid Fraud Control Unit (MFCU), state boards of medicine, state boards of pharmacy, and state boards of nursing. They also represent health professionals and providers in administrative litigation (state and federal) and civil litigation (state and federal). They represent physicians, nurses, medical groups, nursing homes, home health agencies, pharmacies, dentists, pharmacies, assisted living facilities, and other healthcare providers and institutions in recovery actions and termination from Medicare and Medicaid Programs.

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

D’Annunzio, P.J. “Feds Hit Nursing Home With FCA Suit Over ‘Nonexistent’ Care.” Law360. (June 15, 2022). Web.

Marceas, Kimberly. ‘Grossly substandard’ care leads to False Claims charges for Ohio-based nursing home operator. McKnights Long Term Care News. (June 16, 2022). Web.

“Nursing Homes Face DOJ False Claims Suit Over Standards of Care.” Bloomberg Law. (June 15, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

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Trump Administration Reverses Guidelines for Penalties Against Nursing Homes

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Trump administration is actively reversing nursing home guidelines previously put in place under President Barack Obama. The current administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.

The change in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association (AHCA) has complained that under President Obama, inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve or prevent them.

Serious Violations.

Since 2013, federal records show that nearly 6,500 nursing homes have been cited at least once for a serious violation. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.

In 2017, the Centers for Medicare & Medicaid Services (CMS) discouraged its offices from imposing fines, even in the most serious health violations, if the error was a “one-time mistake.”

According to Dr. Kate Goodrich, director of clinical standards and quality at CMS, unnecessary regulation was the main concern that health care providers raised with officials. “Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.

Serious Penalties.

Medicare has various ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. It can deny payments for new admissions.

The average fine in recent years has been $33,453., but 531 nursing homes amassed combined federal fines above $100,000., records show. In 2016, Congress increased the fines to factor in several years of inflation that had not been accounted for previously.

Dr. David Gifford, AHCA’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.

The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.

In November 2017, CMS terminated a Florida Nursing from the Medicare program home after 14 patients died during a hurricane.  You can learn more about this incident and CMS sanctions by clicking the link above.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

If you receive any notice related to any audit, overpayment or action to terminate you or your company, take immediate action. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

We also represent physicians, medical groups, pharmacies. health facilities and therapists in notices of termination of Medicare billing privileges, corrective action plans (CAPs), OIG exclusion hearings, Medicaid hearings and applications for removal from the List of Excluded Individuals and Entities (LEIE).

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Rau, Jordan. “Trump Administration Relaxes Financial Penalties Against Nursing Homes.” Kaiser Health News (KHN). (December 31, 2017). Web.

“Trump Administration Relaxes Financial Penalties Against Nursing Homes.” The Washington Post. (December 31, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Medicare investigations, legal representation for Medicare exclusion, Medicare attorney, Medicare defense attorney, OIG exclusion, legal representation for nursing home compliance, legal representation for nursing home regulations, Centers for Medicare and Medicaid Services (CMS), legal representation for CMS investigations, legal representation for Medicare providers, nursing facility license defense, legal attorney for health facilities, nursing home and skilled nursing facility (SNF) defense attorney, nursing home and skilled nursing facility (SNF) defense lawyer, nursing home and skilled nursing facility (SNF) defense legal counsel, CMS termination of Medicare provider status, legal representation for Medicare reinstatement, legal representation for AHCA investigations and surveys, legal representation for health care compliance, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

 

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

CMS Drops Florida Nursing Home From Medicare Program After 14 Patients Died During Storm

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 12, 2017, federal health officials announced they are dropping a Florida nursing home from the Medicare program after 14 patients died allegedly as a result of the Hurricane Irma emergency. On Sept. 13, 2017, eight residents died and the others were evacuated from the Rehabilitation Center at Hollywood Hills after the facility lost air conditioning. Six more have since died, which attorneys say was a result of the conditions and evacuations immediately after the storm.

CMS Sanctions.

The Centers for Medicare & Medicaid Services (CMS) said in a statement that the facility will be terminated “due to their [sic] failure to meet Medicare’s basic health and safety requirements.” CMS also imposed a penalty of $20,965 a day for the three days that Hollywood Hills lost power to its air conditioning unit.

Under the CMS sanctions, Medicare will continue to pay the Hollywood Hills center through November 12, 2017, for any care that was provided to residents before the evacuation and closure.

This incident is what allegedly prompted Florida Governor Rick Scott to impose emergency rules requiring all nursing homes and assisted-living facilities in Florida (over 3,000 facilities) to have emergency power generators and fuel installed within 60 days to keep their residents air conditioned for up to 96 hours during a power failure. To read more on the emergency rule, click here.

Despite all this, the rehabilitation center has not given up hope on reopening. A spokeswoman for Hollywood Hills said they’ll appeal the decision and look forward to showing evidence that their actions were consistent with all state and federal rules.

To learn more about CMS’s authority to suspend or terminate Medicare to providers, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

If you receive any notice related to any audit, overpayment or action to terminate you or your company, take immediate action. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

We also represent physicians, medical groups, pharmacies. health facilities and therapists in notices of termination of Medicare billing privileges, corrective action plans (CAPs), OIG exclusion hearings, Medicaid hearings and applications for removal from the List of Excluded Individuals and Entities (LEIE).

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Chang, Daniel. “Feds to cut Medicare for Hollywood Hills nursing home after residents died.” Miami Herald. (October 12, 2017). Web.

“Florida nursing home where 14 died cut from Medicare program.” Associated Press. (October 12, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Medicare investigations, legal representation for Medicare exclusion, Medicare attorney, Medicare defense attorney, OIG exclusion, legal representation for nursing home compliance, legal representation for nursing home regulations, Centers for Medicare and Medicaid Services (CMS), legal representation for CMS investigations, legal representation for Medicare providers, nursing facility license defense, legal attorney for health facilities, CMS termination of Medicare provider status, legal representation for Medicare reinstatement, legal representation for health care compliance, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

 

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

CMS Drops Florida Nursing Home From Medicare Program After 14 Patients Died During Storm

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 12, 2017, federal health officials announced they are dropping a Florida nursing home from the Medicare program after 14 patients died allegedly as a result of the Hurricane Irma emergency. On Sept. 13, 2017, eight residents died and the others were evacuated from the Rehabilitation Center at Hollywood Hills after the facility lost air conditioning. Six more have since died, which attorneys say was a result of the conditions and evacuations immediately after the storm.

CMS Sanctions.

The Centers for Medicare & Medicaid Services (CMS) said in a statement that the facility will be terminated “due to their [sic] failure to meet Medicare’s basic health and safety requirements.” CMS also imposed a penalty of $20,965 a day for the three days that Hollywood Hills lost power to its air conditioning unit.

Under the CMS sanctions, Medicare will continue to pay the Hollywood Hills center through November 12, 2017, for any care that was provided to residents before the evacuation and closure.

This incident is what allegedly prompted Florida Governor Rick Scott to impose emergency rules requiring all nursing homes and assisted-living facilities in Florida (over 3,000 facilities) to have emergency power generators and fuel installed within 60 days to keep their residents air conditioned for up to 96 hours during a power failure. To read more on the emergency rule, click here.

Despite all this, the rehabilitation center has not given up hope on reopening. A spokeswoman for Hollywood Hills said they’ll appeal the decision and look forward to showing evidence that their actions were consistent with all state and federal rules.

To learn more about CMS’s authority to suspend or terminate Medicare to providers, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

If you receive any notice related to any audit, overpayment or action to terminate you or your company, take immediate action. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

We also represent physicians, medical groups, pharmacies. health facilities and therapists in notices of termination of Medicare billing privileges, corrective action plans (CAPs), OIG exclusion hearings, Medicaid hearings and applications for removal from the List of Excluded Individuals and Entities (LEIE).

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Chang, Daniel. “Feds to cut Medicare for Hollywood Hills nursing home after residents died.” Miami Herald. (October 12, 2017). Web.

“Florida nursing home where 14 died cut from Medicare program.” Associated Press. (October 12, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Medicare investigations, legal representation for Medicare exclusion, Medicare attorney, Medicare defense attorney, OIG exclusion, legal representation for nursing home compliance, legal representation for nursing home regulations, Centers for Medicare and Medicaid Services (CMS), legal representation for CMS investigations, legal representation for Medicare providers, nursing facility license defense, legal attorney for health facilities, CMS termination of Medicare provider status, legal representation for Medicare reinstatement, legal representation for health care compliance, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

 

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

Trump Administration Reverses Guidelines for Penalties Against Nursing Homes

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Trump administration is actively reversing nursing home guidelines previously put in place under President Barack Obama. The current administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.

The change in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association (AHCA) has complained that under President Obama, inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve or prevent them.

Serious Violations.

Since 2013, federal records show that nearly 6,500 nursing homes have been cited at least once for a serious violation. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.

In 2017, the Centers for Medicare & Medicaid Services (CMS) discouraged its offices from imposing fines, even in the most serious health violations, if the error was a “one-time mistake.”

According to Dr. Kate Goodrich, director of clinical standards and quality at CMS, unnecessary regulation was the main concern that health care providers raised with officials. “Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.

Serious Penalties.

Medicare has various ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. It can deny payments for new admissions.

The average fine in recent years has been $33,453., but 531 nursing homes amassed combined federal fines above $100,000., records show. In 2016, Congress increased the fines to factor in several years of inflation that had not been accounted for previously.

Dr. David Gifford, AHCA’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.

The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.

In November 2017, CMS terminated a Florida Nursing from the Medicare program home after 14 patients died during a hurricane.  You can learn more about this incident and CMS sanctions by clicking the link above.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

If you receive any notice related to any audit, overpayment or action to terminate you or your company, take immediate action. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

We also represent physicians, medical groups, pharmacies. health facilities and therapists in notices of termination of Medicare billing privileges, corrective action plans (CAPs), OIG exclusion hearings, Medicaid hearings and applications for removal from the List of Excluded Individuals and Entities (LEIE).

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Rau, Jordan. “Trump Administration Relaxes Financial Penalties Against Nursing Homes.” Kaiser Health News (KHN). (December 31, 2017). Web.

“Trump Administration Relaxes Financial Penalties Against Nursing Homes.” The Washington Post. (December 31, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Medicare investigations, legal representation for Medicare exclusion, Medicare attorney, Medicare defense attorney, OIG exclusion, legal representation for nursing home compliance, legal representation for nursing home regulations, Centers for Medicare and Medicaid Services (CMS), legal representation for CMS investigations, legal representation for Medicare providers, nursing facility license defense, legal attorney for health facilities, nursing home and skilled nursing facility (SNF) defense attorney, nursing home and skilled nursing facility (SNF) defense lawyer, nursing home and skilled nursing facility (SNF) defense legal counsel, CMS termination of Medicare provider status, legal representation for Medicare reinstatement, legal representation for AHCA investigations and surveys, legal representation for health care compliance, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

 

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

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