Parent company of Carlisle nursing facility to pay $15.4 million to settle overbilling allegations

Forest Park Healthcare and Rehabilitation Center is located at 700 Walnut Bottom Road, Carlisle.
Jason Malmont, The Sentinel

Guardian Elder Care Holdings, the owner of Forest Park Healthcare and Rehabilitation Center in Carlisle, has agreed to pay $15,466,278 to resolve allegations that it over-billed patients.

The Department of Justice announced the settlement in a news release last week.

Guardian operates more than 50 nursing facilities throughout Pennsylvania, Ohio and West Virginia.

According to the news release, Guardian facilities allegedly billed patients at the highest level of Medicare reimbursement from January 2011 through December 2017. Services at that level were not medically necessary, and were influenced by financial considerations.

“Seniors rely on the Medicare program to provide them with appropriate care, and to ensure that they are treated with dignity and respect,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “The department will not tolerate nursing home operators that put their own economic gain ahead of the needs of their residents, and will continue to hold accountable those operators who bill Medicare for unnecessary rehabilitation services.”

The allegations were originally introduced by two former Guardian employees, Phillipa Krause and Julie White, under the whistleblower provisions of the False Claims Act, which allow private parties to sue on behalf of the government for false claims and to share in any recovery. The whistleblowers in this case will receive approximately $2.8 million.

The settlement also resolves allegations voluntarily disclosed by Guardian that it had employed two people who were excluded from federal health care programs. As a result of its employment of those two people, Guardian inappropriately received payment for ineligible services.

Contemporaneous with the civil settlement, Guardian agreed to enter into a chainwide Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General. The agreements are intended to promote compliance and protect nursing home residents.

Full Article & Source:
Parent company of Carlisle nursing facility to pay $15.4 million to settle overbilling allegations

Federal investigation finds three local nursing homes lacking

WASHINGTON — Three central Ohio nursing homes were among 33 in 11 states cited for improper care and billing practices yesterday as part of a $38 million settlement among a major nursing-home company, the U.S. Department of Justice and the state of Ohio.

The announcement in Washington and Columbus resolved an investigation by the federal government, Ohio and seven other states into charges that Extendicare of Canada provided services at those 33 homes that were “materially substandard” or “worthless” because the company did not provide care to residents that meets federal standards, according to the settlement agreement.

The settlement asserts that Extendicare submitted false claims to Medicare between 2007 and last year, charging that the company demanded payment for “medically unreasonable and unnecessary rehabilitation-therapy services” for clients in the 33 homes.

The Columbus Rehabilitation and Subacute Institute in Franklinton, the Arbors East Subacute and Rehabilitation Center on the East Side and the Arbors at London in Madison County were among six Ohio homes cited in the agreement.

At a news conference in Washington, Acting Assistant Attorney General Joyce Branda said, “These problems stemmed in large part from Extendicare’s business model — a model that was driven more by profit and less by the quality of the care it provided.

“Extendicare employed fewer skilled nurses than were needed to care for the very sick residents in those facilities and failed to properly train and supervise the staff it did have.”

Ohio Attorney General Mike DeWine said, “Not only will the states and federal government be reimbursed for the millions that we believe was paid for inadequate care, but we will also make sure that residents living in every Extendicare skilled nursing facility across the country receive the quality care that they depend on and deserve.”

Full Article & Source:
Federal investigation finds three local nursing homes lacking

Virginia: Senior Guardianship Regulations at Issue in the Courts

Arcadius Hakim, 94, of Bailey’s Crossroads served in the U.S. Navy and later became an ear, nose and throat physician, practicing for nearly 50 years and amassing a pretty hefty nest egg. But when he developed dementia in his 80’s and then married a significantly younger woman, his family quarreled about who was to be in charge of Hakim’s finances, and eventually he was appointed a third-party conservator and guardian by a Fairfax County judge.

“My dad is a wonderful guy,” said Dr. John Hakim, a cardiologist and one of three children of Arcadius Hakim. “But when his house burned down in 2002 and he married a much younger woman, we as family members got concerned, and were unsure of how to manage him.”

The McLean law firm of Needham Mitnick & Pollack became Arcadius Hakim’s legal guardians and conservators in 2006, something that is not uncommon in Virginia. A guardian is often needed to care for an incapacitated adult, an adult with mental health issues or a senior who has diminished mental capacity. Additionally, in Virginia a conservator is a person appointed by the court to manage the incapacitated adult’s finances and property when they no longer can.

According to Susan Pollack of Needham Mitnick & Pollack, her law firm specializes in these types of cases, and especially in ones that have familial complications or are considered difficult to manage.
Legal guardian and conservatorship matters are billed at the firm’s professional rates, which can be hundreds of dollars per hour. Virginia Code § 64.2-1208 allows any appointed guardian reasonable compensation for services rendered to an incapacitated adult, but there is no specific definition of “reasonable compensation.”.

Fairfax County Circuit Court Commissioner of Accounts John Rust supervises the billing process by these types of law firms in these cases and for the last few years, the Hakim family has been embroiled in litigation that stemmed from findings issued by Rust in 2011 that some of the fees charged to the Hakim estate by NMP were disproportionate.

Rust concluded in his findings that it was unreasonable for NMP to charge legal rates for non-legal tasks and demanded the firm return $67,358 to the Hakim estate.

Now-retired Fairfax County Circuit Court Judge Leslie Alden ordered a review of the billings, which was then taken before Judge Randy Bellows. The case may soon finally be decided by the Supreme Court.

“They charged my father’s estate $500 to attend a funeral,” said John Hakim. “In other cases, they were charging his estate $200-$300 an hour just to make a phone call on his behalf.”

But NMP’s attorney Bernard DiMuro says all of the charges for services in the Hakim case were reasonable, and that any non-legal tasks were charged accordingly, and not at professional attorney’s rates.

“When NMP was appointed, there was a specific finding and ruling that it could charge professional rates because of the complexity of the case,” he said. “But non-legal tasks were not charged at professional legal rates.”

Full Article and Source:
Senior Guardianship Regulation at Issue in the Courts

Investigations launched into billing by lawyers appointed as guardians

When a woman in his care fell and was injured, an attorney-guardian billed her $135 to talk to her family about what happened and give her father directions to the hospital.

An attorney-guardian charged seniors with dementia legal fees to buy them Christmas presents with their own money.

And another charged an elderly woman $300 for time the lawyer spent eating cookies with her.

When attorneys are appointed as guardians by the Franklin County Probate Court, they are supposed to look out for the best interests of the vulnerable adults, known as wards.

But a yearlong Dispatch investigation shows otherwise and has prompted criminal investigations and court audits. Among those targeted by the court is Columbus lawyer Paul S. Kormanik, who says he has more wards than any other guardian in the country.

A Dispatch examination of thousands of court records found numerous questionable bills that Kormanik submitted to the court, including more than $1,600 in legal fees to clean out a ward’s house so he could sell it. He hired his own family members to do that job, using the ward’s money to pay them.

He also billed the wards thousands of dollars for opening their mail and taking their telephone calls.

Every bill from Kormanik included this message to the court: “The services required by this ward required substantial legal skills and experience.”

Franklin County Probate Court rules specifically state that guardians cannot submit bills at legal rates for non-legal activities. Even so, court magistrates approved them. After The Dispatch raised questions about Kormanik’s billing practices, Probate Court officials began auditing some of his cases last month.

Full Article & Source:
Investigations launched into billing by lawyers appointed as guardians

Report:  Legal System Fails Many Ohioans