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Increased Nursing Home Data Reporting Could Bring ‘Perfect Storm’ of Federal Lawsuits

CHICAGO, IL – In March, the Department of Justice (DOJ) announced the creation of a specialized task force who would be investigating “grossly substandard care” in nursing homes across the United States with both criminal and civil penalties on the table for owners and operators. On March 3 when the DOJ made the announcement, approximately 30 facilities in nine states were under investigation.

The initiative became overshadowed by the COVID-19 pandemic; however, lawyers have emphasized that the initiative is one of several possible venues for government officials to enforce acts of abuse and neglect in nursing home facilities – actions that could be guided by the COVID-19 nursing home data that facilities are required to submit.

On top of the DOJ initiative, the Office of Inspector General (OIG) is reviewing multiple facets of nursing home operations that include the following according to Skilled Nursing News:

  • Medicaid nursing home life-safety and emergency preparedness reviews
  • Audits of nursing home compliance with COVID-19 reporting requirements
  • Why COVID-19 had the effect it did on the hardest hit facilities
  • Infection prevention and control programs in nursing homes
  • Nursing home oversight

According to Brian McGovern, a partner at Crowell & Moring mentioned this is “the perfect storm for a potential wave of lawsuits for targeting facilities with a record in infection control surveys.”

Whistleblowers can also bring lawsuits forward under the False Claims Act (FCA) and seek to recover damages afforded under the act. FCA cases relate to the conduct of private companies that work with Medicare, Medicaid, and other public health funding sources.

The future for FCA cases is that the DOJ has rarely based allegations of the FCA liability on quality of care since it’s a regulatory issue rather than a law enforcement issue.

Department of Justice Launches National Nursing Home Initiative

Attorney General William P. Barr announced the launch of the Department of Justice’s (DOJ) National Nursing Home Initiative (NNHI), which will investigate nursing homes nationwide that provide “grossly substandard” care to their residents. The DOJ indicated that it was dedicating significant resources to partner with the U.S Department of Health and Human Services and local and state prosecutors to respond to life-threatening quality of care issues the nursing home industry currently faces.

The DOJ is committed to combatting elder abuse and financial fraud, as it affects at least 10% of Americans every year. Elder abuse is an intentional or negligent act committed by any person that causes harm or a serious risk of harm to an older adult. Through enforcement actions, training and resources, research, victim services, and public awareness, the DOJ serves to prevent all forms of abuse and neglect.

The DOJ announced nearly 30 investigations in nine states that are currently underway. The NNHI focuses on identifying, investigating, and prosecuting the most problematic nursing homes nationwide, including those that:

  1. Consistently fail to provide adequate care to residents
  2. Failure to adhere to basic protocols of hygiene and infection control
  3. Failure to provide residents with enough food so they become sick or weak
  4. Withholding medication, or
  5. Using physical or chemical restraints or sedating a resident, unless otherwise stated by the resident’s physician

For example, care failure can cause residents to develop pressure sores, or bedsores, down to the bone. Residents should be turned every 2 to 3 hours when laying in a bed, while they should be turned every 15 minutes when sitting in a wheelchair. If nursing home staff act carelessly or fail to do their job, they leave residents vulnerable to developing an illness, or in some instances death.

Federal regulators and law enforcement have had the authority to develop and enforce quality-of-care standards for nursing homes, while state regulators have traditionally played a leading role in investigating and prosecuting nursing homes for quality of care violations. The Department prosecuted claims under the False Claims Act (FCA) which relates to the federal spending on nursing home care for Medicare and Medicaid beneficiaries.

“The HSS Office of Inspector General continues to pursue nursing home operators who provide potentially harmful care to residents who are often unable to protect themselves,” said Chief Counsel to the Inspector General Gregory Demske. “Creating the Initiative sends a message to those in charge of caring for beneficiaries that substandard care will not be tolerated.”

The NNHI is part of a broader commitment by the Department to combat elder abuse and fraud, two things that often happen in nursing facilities. The Elder Justice Initiative (EJI) was developed in 2016, which will coordinate the NNHI. The task force is dedicated to coordinating the prosecution of elder abuse, including physical abuse, financial fraud or exploitation, caregiver negligence or abandonment, sexual abuse, or psychological abuse.

According to a press release by the DOJ, all entities must meet state and federal requirements and are encouraged to consider the following:

  • Reviewing all surveys over the past 5 years and addressing citations of substantial quality of care
  • Ensure all internal and external complaints are appropriately addressed
  • Ensure the entity has a compliance program that flags and escalates any complaints or concerns to ensure they are properly handled

Under the DOJ’s increased scrutiny, operators and investors in nursing homes, assisted living facilities, and other skilled nursing facilities are encouraged to discuss the quality of care standards and concerns.

If you or a loved one has experienced abuse or neglect at the hands of a caregiver, you will need an experienced nursing home neglect and abuse attorney. Our team has proven success in nursing home cases and will use our extensive legal experience to help you navigate the process and to get you full and fair compensation for you or your loved one’s injuries. To receive a free consultation, please call (312) 384-1920 or visit our website.

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