Government Steps Up Enforcement of Nursing Home Rules
"[U]nder instructions from President Clinton to toughen enforcement," the federal government has increased oversight of nursing homes nationwide, resulting in a fivefold increase in fines since 1996. The New York Times reports that the nursing homes cited for violations "have been accused of filing false claims for federal medical insurance when they harmed patients by not meeting federal standards." Ninety-five percent of U.S. nursing homes participate in Medicare or Medicaid, and thus are subject to the federal standards. The following is a sample of cases in which nursing homes were fined or officials were convicted of crimes:
- The 10th Circuit U.S. Court of Appeals "recently upheld a penalty of $1,300 a day" against a Utah nursing home charged with allowing "patients to develop pressure sores, or bedsores," calling the fine "appropriate and reasonable" because the facility "caused harm to patients by flouting federal standards."
- The government recently brought lawsuits against three Philadelphia nursing homes, charging that they had filed "false, fictitious or fraudulent claims" because they failed to provide the services they promised. All reached settlements with the government of more than $60,000.
- In October, an Oklahoma nursing home owner and a former deputy commissioner of the state health department were convicted in federal court on bribery charges after prosecutors said the official had given "favorable treatment" to the owner's nursing homes in exchange for a bribe.
This crackdown stems from a directive President Clinton gave to federal health officials two years ago to "step up enforcement" of the nation's 17,000 nursing homes, which serve 1.6 million people. The results have been tangible: In the fiscal year ending Sept. 30, 1,000 nursing homes were fined, compared to 199 in 1996. This increased oversight has created a "maelstrom" for long term care providers, according to Rodney Johnson, a lawyer in HHS' Dallas office. "On almost any given day in this country, a Medicare-certified nursing home receives a letter from the Health Care Financing Administration, notifying the home that one or more remedies have been imposed, including perhaps civil monetary penalties."
While consumer advocates "welcome the federal crackdown," some providers believe that the government has overstepped its authority. David Shell, a lawyer for the Utah nursing home, said the government had "run amok," adding, "The inspectors, the surveyors, are instructed to find deficiencies. It's very difficult for the homes to win, or even to get a fair hearing." Indeed, according to the Times, many nursing homes choose to settle with the government rather than fight charges because each "false claim" they are cited for leads to a $10,000 fine, "plus three times the amount of any losses sustained by the government." Furthermore, a February Supreme Court ruling made the process for challenging fines in court more arduous. Marie Infante, a Washington lawyer who has assisted several nursing homes, said, "In view of that decision, the cards are stacked in favor of the government now. For nursing homes to pursue an appeal is a tortuous process." To view federal evaluations of "most" nursing homes, go to www.medicare.gov (Pear, New York Times, 12/4).