A report released last year by New York Assemblyman Ron Kim examined the thousands of deaths from Covid-19 in the state’s nursing homes in an attempt to identify underlying problems that caused the raft of fatalities and what can be done to address those problems. The report, published by Kim’s office in July 2020, is available here.
A federal judge ruled against SensotaCare, the largest nursing home provider in New York, saying the agency violated human trafficking laws with its meager wages and “threat of serious financial harm” designed to prevent anyone from quitting. According to Newsday, Judge Gershon of the federal Eastern District of New York also found that the owners of SensotaCare, Benjamin Landa and Bent Philipson, could be held personally liable for violating the anti-trafficking laws.
The ruling continues a decade-long saga between the corrupt owners of the nursing home and the Filipino nurses who say they were required to pay $25,000 if they ever quit their job. At one point, Suffolk County District Attorney Thomas Spota charged thirty nurses who quit en masse with endangering the welfare of children for leaving their position. The charges were overturned by a state court because they violated the rights of the nurses to be “free from slavery.”
A Westchester doctor was convicted of stealing over half-a-million dollars from an elderly woman. According to LoHud.com, physician Peter Corines of Eastchester stole the massive sums from a 97-year-old woman over just a two-week period in November 2017. The jury convicted the disgraced doctor of three felonies stemming from the stolen money and stolen identity that Dr. Corines used to swindle the elderly woman. After being convicted on all counts, the judge sentenced Dr. Corines to three years in prison and told him he “was a disgrace to a noble profession.”
In the criminal complaint, prosecutors said Dr. Corines befriended the 97-year-old and then quickly moved to rob and defraud her of her wealth. The doctor obtained power of attorney from her and quickly emptied her accounts. The shameless doctor also impersonated the woman and opened mutual funds and requested checks in her name. With just a couple weeks, the woman’s entire wealth had been siphoned away by Dr. Corines. Prosecutors say the doctor swindled the senior citizen to pay off personal debts incurred from a failed yacht repair business. When police officers arrested the doctor on April 2018, the doctor only had $11,000 left of the woman’s money.
Medicare’s transition to a new pricing model will reduce the risk of fraud, but likely lower the quality of care for some patients. A report by Skilled Nursing News begins by detailing the new payment scheme implemented by Medicare named Patient-Driven Payment Model, or PDPM. Under PDPM’s new pricing structure, Medicare sets reimbursement rates according to a patient’s healthcare needs. Previously, healthcare providers billed Medicare individually for every service, procedure, or medication. To provide a practical example, if an elderly woman sustained a mild fracture at her nursing home then Medicare would reimburse her nursing home a predetermined amount for similarly-healthy patients who suffer minor fractures. Previously, Medicare would reimburse the nursing home for each itemized healthcare service provided to the injured woman – physical therapy sessions, x-rays, medication, etc. The federal healthcare agency says the reimbursement amount depends on numerous factors including the patient’s health, diagnosis, and care plan.
According to the federal government, the former “pay-for-service” model led to widespread fraud, where healthcare providers provided medically unnecessary services and procedures to their patients just to increase their Medicare billing. Artificially inflated therapy services appear to the most common for the fraudsters. Last year, Signature HealthCARE, the owner of 115 nursing homes across the country, agreed to pay a $30 million fine for defrauding Medicare. In Alabama, SNF Management agreed to a $10 million fine the next month.
Only two weeks after putting a Buffalo nursing home under conservatorship, the New York Department of Health announced that Emerald North and Emerald South Nursing and Rehabilitation Center will be closing their doors. The closure follows a long line of missteps and scandals by the formerly for-profit nursing homes, according to The Buffalo News. In the last year, an elderly woman was beaten to death in the facility’s dementia unit and another nursing home resident died after falling from a third-story window. The two nursing homes, which are owned by the same for-profit organization, were fined over $100,000 in 2017 for not maintaining accurate records on whether patients wanted to be revived in the event of a medical emergency. Tragically, the nursing home’s gross misstep was only discovered after a revived patient was found to have a “do not resuscitate” order.
The nursing homes, which have below average ratings by Medicare, continued to operate with the blessing of the Department of Health for almost an entire year after these scandals. Last month, the Department of Health finally appointed Grand Healthcare System as the nursing homes new operator. At the time of the government agency’s appointment, nursing home residents and their families criticized the appointment of another for-profit nursing home system. Their concerns proved well-founded when Grand Healthcare System announced it would be shutting down both nursing homes and opening new facilities under a different name.
According to Consumer Reports, approximately 500,000 senior citizens lose over $36 billion each year to scammers who target them for financial abuse. Despite the widespread problem and illegality, only 5,000 confirmed cases were reported last year to states. With the population of America aging, authorities expect the problem to grow even worse and hope to bring more awareness to the problem.
Generally, senior citizens are victims of financial abuse by someone who they trust, or someone who pretends to be in a position of trust. In one of the several examples cited by The Daily Item, a convicted felon posed as a licensed building contractor and convinced an elderly woman that she could take a home equity line of credit to finance an expansion. Then, after performing some of the necessary work, claimed he located asbestos and would need more money to continue with the project. As the made-up excuses kept piling up, the felon continued to demand more money from the woman. In a victim statement to a court last year, the elderly woman said she lost over $100,000 and her home was in significantly worse shape. In another example cited by the online newspaper, a man wired money to an unknown bank account after receiving a call from someone pretending to be a federal agent from the Internal Revenue Service.
A recent study estimates that financial abuse of elderly Americans defrauds these vulnerable citizens of almost $37 billion each. The report finds that almost 5 million senior citizens in America are victims of elder abuse each year. In New York alone, financial abuse of the elderly costs at least $1.5 billion a year. While the exact nature of financial abuse can be hard to notice for senior citizens with cognitive impairments, the legal definition perpetuated in the Older Americans Act of 2006 criminalizes “the fraudulent or otherwise illegal, unauthorized, or improper act or process of an individual… that uses the resources of an older individual for monetary or personal benefit, profit, or gain, or that results in depriving the older individual of their use or rightful access to benefits, resources, belongings, or assets.”
The report in Bloomberg Businessweek provides a sad, but unfortunately typical, portrait of elder abuse in 82-year-old Marjorie Jones, who one day received an anonymous call stating she had won a sweepstakes. According to the caller, Jones, who was legally blind and lived alone, would need to pay the taxes and fees on the winnings before the winnings from the sweepstakes could be released to her. After wiring the money to the anonymous caller, more stipulations and conditions became attached and Jones continued to send the money until she had depleted her entire savings, taking out a reverse mortgage on her home, and cashing in on a life insurance policy. Instead of reaching out to her family for help, an ashamed and embarrassed Jones killed herself.
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.
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.
The 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