New York Estate Planning & Elder Law Blog
A U.S. nursing home chain has agreed to pay $38 million in a settlement to end a federal government investigation into whether its nursing homes billed Medicare and Medicaid for poor care for its elderly residents. The settlement was specifically with a subsidiary of Extendicare Inc., Extendicare Health Services.
Extendicare Nursing Homes
The investigation focused on 33 of the company’s nursing home facilities in eight states: Ohio, Pennsylvania, Wisconsin, Indiana, Kentucky, Michigan, Minnesota, and Washington. Extendicare provides post-acute and long-term senior care services. The company has in total 251 different care facilities across the country and the capacity to care for 27,600 residents. It is the seventh largest nursing home chain in the country.
Nursing Home Allegations
The Justice Department claimed that Extendicare understaffed its nursing homes, alleging in some instances of improper catheter care in addition to failure to follow proper procedures that led to falls and bed sores. The company was also under investigation for improper billing of Medicare and Medicaid for things like physical therapy and other senior services.
The care at some of Extendicare’s facilities was so inadequate that some patients became dehydrated and malnourished. They developed infections that led to unnecessary hospitalizations. The company also inflated the number of residents receiving physical therapy and other services in order to bill more to Medicare.
Nursing Home Settlement
According to the U.S. Justice Department, the company has denied any wrongdoing in its billing practices or care of its residents. It agreed to the settlement on the condition that there was no admission of wrongdoing, and the company agreed to be subject to a compliance program that would monitor its residents’ care.
The compliance program is a five year corporate integrity agreement. It requires an independent monitor to check staffing levels and other quality measures to ensure the level of care that its residents are receiving. The agreement applies to every facility owned by Extendicare, not just the 33 sites that were the subject of the investigation.
A lawyer from the Justice Department’s civil division went on record as saying that Extendicare’s program between 2007 and 2013 was driven more by profit and less by quality of care. As a result of the $38 million, two whistleblowers from inside Extendicare’s company will receive awards. One person will be getting $1.8 million and the other over $250,000.
Other Cases of Nursing Home Negligence
This is not the first time that a nursing home company has been accused of fraudulent or negligent practices with their residents. In 2012, the federal government agreed to a $48 million settlement with the nursing home chain Ensign Group due to exaggerated billing to Medicare and Medicaid.
Advocates for nursing home residents have criticized the federal government for failure to look into other claims of negligence and abuse in nursing home facilities. Officials stated that they are planning on investigating more claims of nursing home negligence and would use the False Claims Act to do so. In the case of Extendicare, the government stated that the quality of care was so substandard or nonexistent in some of their facilities that Medicare and Medicaid should not have to reimburse them.