Articles Posted in Fraud

Elderly New Yorkers should carefully examine a nursing home’s finances before making their final decision, according to The New York Times. While full-blown insolvencies are rare, a poorly-run nursing home can offer a “bait-and-switch” type of scheme that lures the elderly in with its low costs, only to reduce services and increase costs in the years to come. According to the newspaper, elderly residents looking to join nursing homes or retirement communities with “joining” or entrance fees should be especially diligent about researching the finances of their facilities. These introductory fees, which can range between several hundred thousand to over a million, will not be returned if the nursing home fails to deliver services or increases its fees in the years, or decades down the road.

With little government regulation on the finances of these of retirement homes or retirement communities, potential residents must perform their own due diligence to ensure their future is safe and secure. This research can be performed by utilizing websites, such as Carf.org or MyLifeSite.net. However, these websites offering information about the finances of nursing homes usually charge a fee.

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A recent report by the Centers for Medicare and Medicaid Services (CMS) found that individuals with mental health or behavioral problems are more likely to be denied access to higher-quality nursing homes throughout the country. The study relied on data from 3.7 million admissions in 15,600 facilities across the country and found that, while elderly Americans with any type of mental health problem faced more difficulty, those diagnosed with more severe illnesses faced even longer odds of admittance. According to healthcare analysts, this is likely a combination of concerns surrounding individuals with mental health problems and a lack of high-quality nursing homes in lower-income areas, which are more likely to have senior citizens with mental health challenges.

CMS assigns a “grade” to each nursing home based on the number of staff at each facility relative to the number of residents, quality benchmarks and the results of health inspections. CMS then assigns a set number of stars to the facility representing its quality, with a one-star facility providing the lowest quality care and a five-star facility providing the highest.

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wallet-300x225The Attorney General’s Office in New York announced the indictment of two Brooklyn men for running a massive scheme to defraud Medicare and Medicaid recipients from healthcare clinics in the Bronx and Manhattan. According to the Attorney General, Tea Kaganovich and Ramazi Mitiashvili, operated three separate companies, Sophisticated Imaging, Inc., East Coast Diagnosists and East West Management, for the sole purpose of defrauding the federal health care system meant to care for the poor and elderly. The Brooklyn men apparently defrauded the government in the amount of $8 million dollars, often to the harm of actual New York residents who looked to the companies to treat their healthcare problems.

The clinics were located at 2423 Adam Clayton Powell Boulevard in Manhattan and 2781 Webster Avenue in the Bronx. Responding to the charges, Attorney General Eric Schneiderman said, “Medicaid is meant to be a healthcare safety net for New Yorkers, not a bank account for criminals.” Continue reading

nursing-home-1-300x137After reaching an agreement with the Attorney General, a New York nursing home chain is prepared to grow throughout the tri-state area. The Brooklyn retirement home chain, Allure Group, came under heavy criticism after purchasing a retirement home and assisted living facility for New Yorkers living with HIV/AIDS and then subsequently selling the properties to luxury developers. After Allure’s growth plans were halted by a state investigation into the matter, Allure seems poised to rapidly expand – with the purchase of Greater Harlem Nursing first on its list.

Allure was started in 2010 by Marvin Rubin and Joel Landau when they purchased the vacant Victory Memorial Hospital in Bay Ridge for $20 million, according to Crain’s New York. The pair changed the name to Hamilton Park Nursing and Rehabilitation Center, a successful purchase for the pair that led to buying four more nursing homes in Brooklyn. Allure’s assisted living facilities now have a revenue stream of almost $200 million a year. Continue reading

A recent federal and state report excoriated New York’s handling of complaints against nursing homes and nurses in the state.

An audit by the New York found that the state had failed to properly investigate complaints against nurses. For the cases that are deemed “priority 1” – the most serious which usually involve allegations of sexual misconduct or abuse – New York took an average of 228 days to investigate. State law re

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quires these investigations to conclude within 10 days of the complaint. In one horrific case, New York failed to sanction, or otherwise discipline a nurse in any way, after she administered an overdose of insulin that nearly killed a patient. In another case, it took New York almost a year-and-a-half to revoke the nursing license from a Bronx nurse who sexually assaulted a patient.

New York performs even worse when factoring in lower-priority complaints against medical care professionals. With over 8,000 complaints lodged between April 2014 and April 2017, more than 2,000 were not performed within the required 180-day time period.

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Governor Andrew Cuomo has taken a stand against elder abuse by signing a new law that requires state agencies to develop guidelines to help better identify elder abuse. According to Gov. Cuomo, the new guidelines will be proactive by establishing guidelines to help identify cases of elder abuse, self-neglect and maltreatment and comprehensive by following-up with any at-risk senior citizens. Further, these guidelines will be shared not only with state agencies, but also with healthcare providers who are often in the best position to identify potential elder abuse.

This new law hopes to increase the reporting rate by educating and empowering neutral third-parties that frequently interact with senior citizens in the state – including government agencies, healthcare providers and even banks. According to Assemblywoman Donna Lupardo, sponsor elderly-woman-on-phone-300x200of the bill, involving the healthcare industry will be pivotal in countering “one of the most under-reported crimes” in the nation. Because the doctor-patient relationship generally involves an implicit trust and regular interactions (especially for elderly citizens), Lupardo notes that healthcare providers are in the best position to assess and monitor potential elder abuse. Continue reading

As part of President Trump’s promise to roll-back federal regulations, the Trump administration has announced its intention to scrap a federal rule prohibiting nursing homes from requiring their residents to pursue legal claims through arbitration.

In the simplest terms, arbitration is a catch-all term for a dispute-resolution that, while legally binding, does not utilize the court system. The practice has exploded in popularity in recent decades – especially among larger corporations and nursing homes. These entities prefer arbitration because the costs are generally lower, the dispute resolution process moves much faster than the courts, and parties generally do not have a right to appeal thus providing both parties some finality to their dispwalking-out-300x225ute. Opponents of arbitration say the extra-judicial process favors corporate interests and curtails the rights of victims – from limiting discovery to removing the opportunity to appeal. Further, arbitration also removes the right for a person to have their case heard before a jury, and instead substitutes a so-called “neutral arbitrator.”
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As more than 10,000 Americans join the 65-and-over club daily, financial exploitation of the elderly is becoming increasingly more common and states are making moves to protect their senior citizens. Financial abuse, one of the four types of elder abuse (the other three include sexual abuse, physical abuse and emotional abuse) involves the “illegal or improper use of a senior citizen’s funds, property or assets, as well as fraud or identity theft perpetrated against older adults,” according to the National Conference of State Legislatures. Currently 33 states have laws directly addressing financial abuse of the elder – a nine-state increase since 2015.

wallet-300x225Advocates say that the largest problem with prosecuting financial abuse of the elderly is that it often goes unreported. First, many elderly victims do not even know that a crime has been committed. For example, Mariana Cooper, an elderly widow living by herself, gave a $217,000 loan to a woman who had slyly gained her trust. It was not until six months after she realized she was not going to be repaid that Ms. Cooper alerted the police. Even then, Ms. Cooper only filed a report at the urging of her daughter who, again, only found out until six months after-the-fact. Telling her story to the New York Times, she said she felt because she freely gave the money away that no crime had been committed and she was too ashamed to tell her family how she had been cruelly defrauded.

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With toothless regulations and ineffective oversight, many nursing homes are still failing the neediest patients. With its budget for overseeing nursing homes slashed in half, the Center for Medicare and Medicaid Services (CMS) has failed to identify failing nursing homes and keep them accountable. As a consequence, some nursing homes are choosing to accept the infrequent fines instead of changing their behavior.

helpCMS is responsible for overseeing all nursing homes that receive benefits from these federal entitlement programs. CMS routinely inspects nursing homes for any violations, if a violation is found, then CMS has two options. First, CMS can put the facility on “special focus” status – reserved for the worst offenders. A nursing home with this designation would be routinely inspected more often and, supposedly, would be punished more severely for any violations. Unfortunately, federal budget cuts have blunted the amount of nursing homes that can be put under “special focus.” Since 2012, the budget for inspecting facilities with this designation has dropped by half. Consequently, despite regulators identifying 435 facilities that warranted this designation, only 88 nursing homes were actually put on the watchlist. Further, once a Continue reading

physical-abuse-300x169A Berkshires caretaker has been charged with elder abuse after an 84-year-old man told hospital staff that his two broken ribs were caused by being “thrown around like a rag doll.” The 52-year-old man, Anthony Marcella II, was arraigned in Central Berkshire District Court on charges of assault and battery on a person over 60 or disabled, witness intimidation, caretaker abuse of an elder, and caretaker abuse of an elder causing serious bodily harm. Marcella has pleaded not-guilty to all charges and was released on a bail.

On May 22 or 23, Marcella was allegedly “rough” when picking up the elderly victim (whose name is not provided) after he fell down. According to court documents, Marcella squeezed him in an aggressive manner and proceeded to throw him around “like a rag doll.” The elderly victim suffered two broken ribs as a result of his caretaker’s abusive treatment. Continue reading

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