Congressional list reveals poorly performing SC nursing homes

Riverside Health and Rehab in North Charleston was one of six South Carolina nursing homes that were named on a congressional list of poor-performing facilities. This is information that normally isn’t provided to the public. Brad Nettles/Staff

Six nursing homes in South Carolina were identified as consistently poor-performing in a congressional list previously kept secret by a branch of the Department of Health and Human Services.

The list, current as of April, was released to the Senate Special Committee on Aging at the beginning of June after a bipartisan inquiry from Pennsylvania Sens. Bob Casey, a Democrat, and Pat Toomey, a Republican.

“It is outrageous that we continue to hear stories of abuse and neglect in nursing homes that do not live up to these high standards,” Casey said in a news release. “Choosing a nursing home is a difficult and often painful decision to make. Individuals and families deserve to have all the information available to choose the facility that is right for them.”

The Centers for Medicare and Medicaid Services, the federal office in charge of administering Medicare and Medicaid, keeps a list of nursing homes that are designated as Special Focus Facilities. This designation increases the frequency that a nursing home must be inspected and sets guidelines for where and how quickly a facility must improve.

Homes that meet safety and health guidelines are typically inspected every nine to 15 months. If a facility is classified as a Special Focus Facility, however, it must be inspected every six months and must graduate from the SFF designation within 18 months or it risks losing the ability to offer Medicare or Medicaid.

The list of SFF-designated facilities has previously been made publicly available. But until now, the Centers for Medicare and Medicaid Services had shielded from the public eye the list of roughly 400 facilities that were considered for the program but didn’t make the cut.

Riverside Health and Rehab in North Charleston is the only facility in the state given the full SFF designation. The other five South Carolina facilities listed in the report were listed as candidates for the SFF program:

• Commander Nursing Center, Florence
• Blue Ridge of Sumter
• Life Care Center of Hilton Head
• Compass Post Acute Rehabilitation, Conway
• PruittHealth — Blythewood, Columbia

The list does not make clear the number or kind of violations any of the facilities were cited for, nor does it mark their progress in fixing any issues. Medicare.gov, however, does periodically update a nursing home’s database with information from safety and health inspections, as well as any penalties a nursing home has incurred.

Riverside Health and Rehab, for instance, has been fined four times since 2017 totaling over $322,000. In its most recent health inspection from February 2018 it was cited for three different violations.

In an emailed statement, Riverside said that since it began in the Special Focus Facility program in April 2017, results from subsequent inspections have shown the facility continues to improve. In May, the statement said, the facility graduated from the program.

“Our residents will remain our first priority and we will continue working hard to achieve our goal of providing the highest quality care possible in a home-like environment,” said Riverside administrator Jerrolyn Montgomery-Smalls.

U.S. Sen. Tim Scott, R-S.C., sits on the Senate Special Committee for Aging and said through a spokesman that while a majority of South Carolina facilities provide high-quality care, transparency in identifying the ones that don’t is an important initiative.

“Senator Scott believes in transparency and daylight is a positive antiseptic,” said spokesman Ken Farnaso. “Anytime we can improve the quality of an elderly person’s life, we should.”

Farnaso added that Scott is working with multiple committees to advance quality improvement initiatives and “safeguard our state’s increasingly growing older population” but did not elaborate.

Shortly after getting the initial list of facilities considered for SFF designation, Casey and Toomey announced that the Centers for Medicare and Medicaid Services had committed to releasing for the first time a monthly update of nursing homes considered for the SFF program. 

Full Article & Source: 
Congressional list reveals poorly performing SC nursing homes

NJ: Should Nursing Homes be Required to Have More Aides? Legislation Says Yes

In a move intended to improve the treatment and safety inside New Jersey's nursing homes, a state Assembly panel Monday approved a bill that would set minimum staffing standards for certified nursing assistants.

The bill targets the professionals on whom residents rely the most to meet their basic needs — from eating, bathing, dressing and administering medications.

Nursing homes would have to require one nursing assistant be on duty for every eight residents on the day shift, for every 10 on the late day shift, and one for every 16 residents on the overnight shift.

The Assembly Human Services Committee voted 4-2 to pass the bill (A4636) despite the objections of nursing home operators, who argued quotas would interfere with daily managerial decisions they make based on the specific medical and emotional needs of residents.

Industry officials said passing a law won't change the fact that assistants or "CNA's" are in short supply in New Jersey and nationally.

According to the U.S. Bureau of Labor Statistics, there were 1.4 million certified nursing assistants nationwide whose median salary was $25,000 last year, although some made as little as $18,790.

Generally, a nursing aide is required to have 75 hours of training.

Annual turnover in the field is among the highest in any industry - exceeding 100 percent in some years because the work is difficult and pay isn't competitive, according to a 2004 report by the U.S. Department of Health and Human Services.

The report said 1.2 million more nursing assistants would be needed to keep up for the demand for care as the baby boomer population ages.

Full Article and Source:
NJ Assembly Panel Acts to Create Staffing Quota

Could a Caregiver Corps Solve the Caregiving Shortage?

A recent report from AARP found that we are on the verge of facing a major caregiver shortage in the not-so-distant future. According to their report, in 2010, there were "more than 7 potential caregivers for every person in the high-risk years of 80-plus" and by 2030, the projected ratio will fall to 4 people for every person 80-plus. And by 2050, "it is expected to further fall to less than 3 to 1."

Aging in place has become an important part of aging in America. Whether due to the struggling economy, comfort or deeper personal reasons, people simply do not want to spend their later years in nursing homes or assisted living facilities; they prefer to grow old in their own homes, usually with the help of their grown children. For the last decade or so, this has been made possible thanks to their children and amenities offered by both private companies and local governments to assist the elderly with aging in place.

Baby Boomers, however, may not be as lucky. Boomer women had fewer children than their parents and some opted out of having children at all. Combine that with higher divorce rates -- by 2030, 36 percent of older men will have been alone for a decade or longer -- and we've got a Caregiver shortage crisis on our hands.

Senator Bob Casey, a Democrat out of Pennsylvania, sits on the U.S. Senate Aging Committee and has spent many hours listening to the testimony of people who are struggling to care for aging parents. Based on what he's heard, he's working on developing a National Caregiver Corps. According to a press release on Senator Casey's website, he plans "to introduce legislation to establish a Caregiver Corps program to foster the creation of community-based programs that can help 'fill the gap' in assisting older adults and individuals with disabilities, and in providing added support for informal caregivers." The goal of the program is to ease the burden of low-income and middle class families who have been struggling with how to balance work and family responsibility.

Volunteers who participate in the program would receive specific guidelines and structure from the Department of Health and Human Services in order to provide assistance to families by "cleaning, preparing food or even shopping for people who want to remain at home" as they age, as well as respite care for existing family caregivers. The proposal also includes providing volunteers with a stipend, tuition credit or even academic credits.

Full Article and Source:
Could a Caregiver Corps Solve the Caregiving Shortage?

Michigan Family: Caregiver Wed, Left Elderly Man Broke

Frank Calcaterra was in his 80s in 2008 when his family hired a home care company to help the former Detroit-area funeral home owner look after his ailing wife Jonnie, who had dementia.

Tangi Coleman, Aged 35

The company — Kentucky-based ResCare — sent Tangie Coleman, who, at the time, had a warrant out for her arrest, records show.

Jonnie's jewelry soon began to disappear, as did Frank Calcaterra's sizable fortune — estimates from court filings put the loss at anywhere from more than $500,000 to more than $1.5 million. When Jonnie Calcaterra died in a nursing home in January 2012, Coleman and her mother were living in Frank Calcaterra's lakefront home in Waterford, Mich., and he was sleeping in the basement.

A few months later, Coleman married Calcaterra in Ohio, without his family's knowledge.

In April, when Frank Calcaterra's daughters removed him from his home, he was 10 pounds lighter and so broke he no longer had a positive bank balance or a valid credit card. Coleman was driving him to a check cashing place with his monthly Social Security check, his daughters say.

The case highlights what experts say is a significant and growing problem in the U.S. — financial exploitation of elderly people by caregivers. Many cases go unreported and accurate estimates are hard to pin down, but studies suggest there are at least tens of thousands of such cases each year.

In Michigan, more than 10% of the 33,710 adult abuse complaints the state received in 2013 — up from about 21,000 in 2011 — related to alleged financial exploitation. The state substantiated financial exploitation in more than 1,000 cases.

"We're seeing more and more of these cases where people pose as legitimate caregivers, befriend the elderly, become a part of their lives, and then start taking advantage of them," said Jim McGuire, director of research for the Area Agency on Aging 1-B in Southfield, Mich., which serves about 30% of the state's senior population in six counties.

Who's accountable?
Residential home care companies don't require state licensing, and criminal background checks for their workers are only mandatory if public funds are used to pay them.

Though Michigan has recently toughened laws and penalties related to financial exploitation of seniors, making background checks mandatory for all home care workers could have helped Calcaterra, said McGuire, as could a bill stalled in the state Legislature making it mandatory for financial institutions to report suspicious banking activity affecting seniors' accounts.

On Oct. 25, 2012, when Coleman, who was 35, and Frank Calcaterra, who was 86, were married in Ohio, at least two complaints alleging financial exploitation had been filed with the Michigan Department of Human Services' division of Adult Protective Services.

In May of this year, an Oakland County, Mich., judge appointed a conservator for Calcaterra, citing fraud and financial exploitation, which Coleman denies

Full Article and Source:
Family:  Caregiver Wed, Left Elderly Man Broke

Deaths in 2 Senior Homes Highlight Sharp Rise in Abuse, Neglect

Staff members at two Minnesota homes for elderly people failed to provide adequate medical care and monitoring, resulting in the deaths of two residents, according to investigation reports released Thursday by the Minnesota Department of Health.

 

The fatalities come amid a sharp rise in reports of abuse and neglect at homes for senior citizens across Minnesota. The number of maltreatment complaints received by state authorities involving nursing homes, home care and assisted-living facilities nearly tripled to 1,217 in 2013 from 451 in 2010, according to a report issued last month by the Department of Health.

 

In the latest reports, an elderly resident with dementia was not provided with any fluids, food or monitoring for more than 18 hours in May because staffers at the home, Summit Hill Senior Living in St. Paul, were unaware that the client had been transferred to the facility’s “memory care” unit. The resident was found on the toilet with multiple abrasions and died the following morning, state investigators found.

 

In another case, a nursing assistant at Boundary Waters Care Center in Ely, Minn., stopped providing oxygen to a resident who was having difficulty breathing and then sent the resident in a nonemergency transport van to an appointment more than two hours away. The resident later died of cardio-respiratory arrest.

 

Elder care advocates attribute the increase in the number of complaints to better reporting, poor staffing levels and heightened public awareness of senior abuse.

 

In an unusual move, the state Department of Health in June seized control of Camden Care Center, a Minneapolis nursing home, after inspections turned up more than 80 infractions, many of them serious. Regulators found that two residents required hospitalization after accessing drugs or alcohol while under the facility’s care, among other violations.

 

“It’s really disturbing to see the numbers of complaints going up,” said Iris Freeman, director of the Vulnerable Adult Justice Project at William Mitchell College of Law. “It could be a measure of stronger action on the part of people who suspect they are observing abuse.”

 

In response to rapid growth in the senior care industry, the Department of Health has roughly doubled its investigative staff to 20 people over the past five years.

 

Full Article and Source:
Deaths in 2 Senior Homes Highlight Sharp Rise in Abuse, Neglect

TX: New Rules for Elder Care Facilities After KXAN Investigation

KXAN’s Investigation into alleged sexual assaults at an Austin assisted living facility has triggered coming changes to help better protect your elderly loved ones.  In May we first told you about the allegations Longhorn Village, a retirement community and assisted living center created by the University of Texas Alumni Association – the Texas Exes. During our investigation the Texas Department of Aging and Disability (DADS) services admitted it broke state law in the course of its investigation of the allegations.

We discovered that despite having a court ordered guardianship stating she was mentally incapacitated and incapable of making her own decisions, DADS investigators didn’t have it before determining the sexual assault allegations were unsubstantiated.  Neither Longhorn Village nor DADS reported the allegations to law enforcement, as required by state law.

Now, because of what we uncovered, elder care facilities in Texas will be required to keep guardianship orders on file for residents who have them.

“We are going to have positive change,” said state representative Elliot Naishtat, who saw our story and took immediate action. Naishtat is the Vice Chairman of the House Committee on Public Health and also sits on the House Committee on Public Health and House Committee on Aging. He says since our investigation aired he has been in discussions with top officials at the Texas Health and Human Services Commission (HHSC) and DADS.

DADS, which oversees elder care facilities in Texas, will also have new marching orders.

“Any investigator or case worker who has a situation where there are concerns about the resident who has been abused or neglect will be able to go to the file and see whether or not letters of guardianship have been issued for this individual and then to act accordingly,” said Rep. Naishtat.

First, DADS will direct facilities to keep guardianship orders in a resident’s file.  Then the state will adopt new rules officially requiring it.  Representative Naishtat says he will introduce a bill in the upcoming legislative session proposing penalties for those who don’t follow the new rules.

“We support the idea of having some notation on a medical record that a person has a guardian,” said DADS spokesperson, Melissa Gale.

But does that go far enough?  For the alleged victim in our investigation, maybe not.  Her family alleges in a lawsuit against Longhorn Village that a male resident sexually assaulted her there in 2012.  The suit also alleges staff did nothing to protect her even though she had a guardianship order.

DADS reopened the case after our investigation and finally reported the allegations to law enforcement, but again determined the allegations to be “unsubstantiated.”

“The facility believed it was protecting this resident’s rights,” said Gale, “…the right to engage in a relationship.  The right to privacy and independence,” she continued.

“Even though she was ruled incapacitated by a court, they still felt like they didn’t need to communicate what was going on to the family or the state or a law enforcement agency?”  asked Brian Collister.

“After interviewing residents, staff, they concluded, the investigator determined that the facility had not violated any regulations in protecting this woman,” Gale responded.

Full Article and Source:
New Rules for Elder Care Facilities After KXAN Investigation

Federal Nursing Home Enforcement System is Not Punitive: Setting the Record Straight Again

The Department of Health and Human Services' Inspector General recently reported that nearly one third-of nursing home residents suffered an adverse event or other harm during a stay in a Medicare-participating nursing home in August 2011, and that most of the adverse events or other harm were preventable and the result of problems in staffing.[1]  Despite evidence of poor quality of care, the nursing home industry continues calls for a "new examination" of the public oversight process, choosing to believe the oversight process, rather than the care itself, is the problem.[2]

Industry challenges to the federal oversight system are certainly not new.[3]  Nevertheless, in light of the industry's continued attacks on the regulatory system and its call for a new method of nursing facility oversight, it is time to set the record straight again: the regulatory system does not need a "new examination." Rather, it needs to be fully and effectively implemented.

Industry Claims

LeadingAge, the national trade association of not-for-profit nursing facilities, claims that the current enforcement system is punitive and does not serve its primary purpose of protecting residents and ensuring quality.  It proposes what it calls "an objective, third-party examination of the present federal-state nursing home oversight process."[4]  In support of its proposal, the trade association cites the Inspector General's March 2014 report about adverse events and harm, a series of reports by the Government Accountability Office (GAO) "issued over the past decade [that] have found that the present nursing home oversight process is inadequate to ensure quality care and is overwhelming for regulatory agencies to administer,"[5] and its own 2006 report, Broken and Beyond Repair.[6]  LeadingAge describes the regulatory system as "a punitive oversight process, built on fines and punishment"[7] and touts its own initiatives, notably Advancing Excellence in America's Nursing Homes and Quality First, as the solution to poor quality of care.

The Federal Regulatory System Is Not Punitive

The Inspector General's (IG's) recent report identifying extraordinarily poor care for Medicare residents does not support LeadingAge's thesis that the regulatory system is poorly designed and punitive.  Similarly, reports issued by the Government Accountability Office (GAO) offer no support for LeadingAge's claim.  Over the past decade, the IG and the GAO have uniformly reported that it is not the regulatory system itself that is the problem, but rather the implementation of the system, finding, specifically, that implementation has been too ineffectual, too timid, and too poorly used to make a difference.  Not even the reports cited by industry groups claim that the enforcement system has been fully implemented and nevertheless failed to improve care for residents.  GAO report titles graphically make this point: Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment,[8] Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses,[9] Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents,[10] Nursing Home Deaths: Arkansas Coroner Referrals Confirm Weaknesses in State and Federal Oversight of Quality of Care.[11]

Full Article & Source:
Federal Nursing Home Enforcement System is Not Punitive: Setting the Record Straight Again

County Attorney Amends Charges in Guardianship Embezzling Case

A Bayard woman accused of embezzling from state wards now faces nine felony and two misdemeanor charges.

Amended charges against Judith (Judy) Widener, 70, were filed Feb. 24 in Scotts Bluff County District Court, according to court records. Four Class IV felony counts of theft by taking, five Class III felony counts of theft by taking and two Class II misdemeanor counts of theft by taking were filed.

 

Widener is believed to have embezzled more than $14,000 from guardianship accounts using a variety of methods, according to previous testimony given during a December preliminary hearing held in Scotts Bluff County Court.
 

During the preliminary hearing, Craig Kubick, of the Nebraska State Auditor’s Office, testified he discovered a series of red flags when he reviewed the state’s Assistance to Aged, Blind and Disabled Program, a program administered by the Nebraska Department of Health and Human Services. Kubrick established that an investigation by the Nebraska State Auditor’s Office determined that Widener had embezzled more than $14,000 by using a variety of methods when she served as executive director of Safe Haven and acted as a guardian to state wards.
 

Kubrick testified that Widener had allegedly accepted funds on behalf of dead state wards, had double billed for services and had even used funds for wards to make personal payments to credit cards and for phone and television services to her home. He testified that the woman had also written checks from guardianship accounts for birthday and Christmas gifts to herself.
 

Widener’s case has served as an example of the need for reform of the guardianships overseen by the Nebraska courts. The Nebraska Legislature has proposed a bill to establish a state Office of Public Guardian. The bill would create an office to provide guardians to serve as conservators when a ward does not have a family member or other suitable person to oversee affairs.
 

During the annual State of the Judiciary address in January, Chief Justice Michael Heavican also promised changes in the way that the courts oversee guardianships. The courts are developing an internal audit system for guardianship to notify judges when a guardian has been removed from a case for cause, he said.
 

Widener is currently scheduled to be tried during the June jury term.

Full Article and Source:
County Attorney Amends Charges in Guardianship Embezzling Case

See Also:
Nebraska State Auditor:  Guardian Fleeced State Wards

Year-Long Investigation Nets Charges of MO Man Exploiting Elderly, Stealing

Following more than a year long investigation, Charlie Day, 83,  of Troy, has been charged with two felonies including exploitation of the elderly and stealing. Both are class B felonies. The case was investigated by the Missouri Department of Health and Human Services (DHSS). Gregery Martin, led the investigation.  The charges were filed Feb. 10 in the Lincoln County Circuit Court. Day was released on Feb. 18 on a $25,000 bond.

According to court documents,  it  states that  Mr. Day ‘used undue influence, by improper use of a power of attorney, to obtain more than $50,000 from the victim (assets including bank accounts,  CD and  credit card). Mr. Day drew on those assets by making cash advances, taking withdrawals and writing/depositing checks in a number of banking institutions located in and around the City of Troy, County of Lincoln, State of Missouri. The victim, age 83, is an elderly man as defined by statute and is incapacitated. Mr. Day, through his actions, benefited himself and detrimentally affected the man.’

Full Article and Source:
Year Long Investigation Nets Charges of Exploiting Elderly, Stealing

Appeal of $10,000 Fine to CA Facility for Leaving Suicidal Patient Unattended is Denied

A federal appeals court has upheld a $10,000 fine against a skilled nursing facility for leaving a suicidal patient unattended, who then walked out of the facility and killed himself.

The U.S. Court of Appeals for the Ninth Circuit said the Department of Health and Human Services' ruled that the decision (Del Rosa Villa v. Sebelius, 2013 BL 330965, 9th Cir., No. 12-71685, 11/26/13) to fine petitioner Del Rosa Villa was supported by substantial evidence. The court denied a petition to overrule decisions that led to the fine.

The unidentified patient first received care at Del Rosa Villa in May 2009 after he broke his leg in a suicide attempt. Hospital employees who treated the man noted psychiatric issues and a risk of self-harm.

After admission to Del Rosa Villa, a nurse noted that the patient should be put on 24-hour suicide watch. The patient was sent to the emergency room after Del Rosa Villa staff couldn't calm him June 5. The patient returned two days later and resumed the unusual behavior. On June 9, the nursing staff allowed him to go outside the facility to smoke, according to court records. He was found 20 minutes later hanging from his belt.

Full Article and Source:
Nursing Home $10,000 Suicide Fine Upheld

Nebraska State Auditor: Guardian Fleeced State Wards

Judith Widener of Scottsbluff has confessed to embezzling money from state wards who could not take care of themselves, Nebraska State Auditor Mike Foley said Monday in a press conference.

Widener, 70, had 46 wards in Lincoln County, according to the state auditor's report.  

In a finding of wide ranging fraud, Foley said Widener, a Health and Human Services guardian with 600 clients scattered across the state, is under prosecution.

 

Widener confessed Wednesday to auditors, accompanied by the Nebraska State Patrol. She was jailed Friday in Scottsbluff.

 

She held an array of credit cards and more than 40 bank accounts that could have been used to shuffle money. Foley said her bank accounts contained more than $600,000.

 

She made a recorded confession to the auditors, indicating she knowingly misappropriated monies that belonged to wards, Foley said.

 

She is held on $500,000 bond.

 

Widener also operated a debt and credit counseling service company called Safe Haven, Inc.

 

Widener's alleged embezzlement was the worst case among several, Foley said. Auditors looked at assistance programs for roughly 6,000 vulnerable Nebraskans who are elderly, blind, or disabled.

 

The programs are run by the Nebraska Department of Health and Human Services and cost nearly $15 million a year in state tax dollars. The audit team found the programs to be riddled with problems – some of which are criminal in nature, Foley said.

 

The random check by auditors found, in 36% of the instances that were reviewed, the Department of Health and Human Services was making cash payments for living expenses or medical payments that were unreasonable or in direct violation of state law or regulations, Foley said.

 

Full Article and Source:
State Auditor:  Guardian Fleeced State Wards

What is the Elder Justice Coordinating Council?

The Elder Justice Act of 2009, as part of the Affordable Care Act, establishes the Elder Justice Coordinating Council to coordinate activities related to elder abuse, neglect, and exploitation across the Federal government. The Elder Justice Coordinating Council is directed by the Office of the Secretary of Health and Human Services and the Secretary serves as the Chair of the Council. Secretary Sebelius assigned responsibility for implementing the Coordinating Council to the Administration on Community Living/Administration on Aging. The Administration on Aging has long been engaged in efforts to protect older individuals from elder abuse including financial exploitation, physical abuse, neglect, psychological abuse, and sexual abuse. Through the Older Americans Act, the Administration on Aging endeavors to preserve the rights of older people and protect those who may not be able to protect themselves.

The Elder Justice Act also names the Attorney General of the United States as a permanent member of the Council. In addition to the Secretary of Health and Human Services and the Attorney General, the statute provides for inclusion as Council members the heads of each Federal department, agency or governmental entity identified as administering programs related to abuse, neglect, or financial exploitation.

Source:
Elder Justice Coordinating Council

See Also:
Member List

Millions in Disability Housing Aid on Way

Nearly $98 million in rental assistance is headed to states to help thousands of people with disabilities live in the community.

The federal money is expected to fund 3,530 housing units in 13 states for people who require long-term services and supports to live independently, the U.S. Department of Housing and Urban Development said this week. Housing agencies within the states are now working with Medicaid and Health and Human Services officials to identify very low-income individuals with disabilities who are in need of the rental assistance.

Federal officials say they expect many people receiving the new funds to be transitioning out of institutions.

“Our nation is strongest when all our citizens are able to fully participate and contribute,” said Secretary of Health and Human Services Kathleen Sebelius. “This unique collaboration of federal and state agencies will enable thousands of Americans with disabilities to lead productive, meaningful lives in their communities.”

Full Article and Source:
Disability Scoop: Millions in Disability Housing Aid on Way

Former Okla. DHS worker charged with wire fraud

 

OKLAHOMA CITY (AP) — A former Oklahoma Department of Human Services worker faces federal wire fraud charges after allegedly bilking a Bethany nursing home resident out of more than $27,000 in disability payments.

 

Katharine A. Daugherty, a former DHS adult protective services specialist, has agreed to a plea deal with federal prosecutors in which she will plead guilty to the charges and make restitution payments, her attorney Irven Box said.

 

"She has accepted responsibility for what she did and acknowledged that what she did was wrong," Box said.

 

Daugherty is expected to enter a guilty plea at a hearing Wednesday in U.S. District Court for the Western District of Oklahoma. She will also forfeit her state pension as part of the guilty plea.

 

According to the charges, Daugherty had guardianship over a man identified only as "L.J.A." in court documents. The man was a former Federal Aviation Administration employee who received monthly disability payments from the U.S. Department for Labor for an on-the-job injury sustained in 1976.

Full Article and Source:
Former Okla. DHS worker charged with wire fraud

See Also:
Former Oklahoma DHS Worker Charged With Mail Fraud

Former Oklahoma DHS Worker Charged With Mail Fraud

A DHS worker kept hidden from the federal government that a disabled adult had died so she could get his monthly benefits checks and use the funds “for her personal benefit,” prosecutors allege.

Katharine A. Daugherty, 57, of Bethany, is charged in Oklahoma City federal court with wire fraud.

Because of the scheme, the U.S. Labor Department was cheated out of more than $27,000, prosecutors allege.

Daugherty retired from the Oklahoma Department of Human Services in August 2011 after learning she was under investigation. She was an adult protective services specialist IV.

Her attorney, Irven Box, said she has accepted responsibility for her actions and intends to plead guilty to the felony charge. A hearing is set for Wednesday.

Full Article and Source:
Former Oklahoma DHS worker charged with wire fraud

CCHR: Psychiatric Abuse of the Elderly

An estimated 15,000 Elderly patients are killed ever year from antipsychotic drugs - while thousands more are electroshocked.

Psychiatry and those who follow their practices (drugs, restraints, electroshock) have no reverence or respect for the elderly, and employ dangerous drugs and 'treatments' as a method of control and keeping them quiet. They will happily supply endless prescriptions of psychoactive drugs or ECT. In just a six-month time period in 2007, Medicare received $309 million in claims for antipsychotics for elderly in nursing homes. Daniel R. Levinson, Office of Inspector General (OIG), Department of Health and Human Services, stated recently, "Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there's ample evidence that some drug companies aggressively marketed their products towards such populations, putting profits before safety.... Government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged -- and seek solutions."

FBI: GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

The FBI - Federal Bureau of Investigation
Boston Division

GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

Largest Health Care Fraud Settlement in U.S. History

U.S. Department of Justice
July 02, 2012 Office of Public Affairs
(202) 514-2007/TDD (202) 514-1888

Breaking News, Financial, Fraud, Health Care Fraud, Press Release

WASHINGTON—Global health care giant GlaxoSmithKline LLC (GSK) agreed to plead guilty and to pay $3 billion to resolve its criminal and civil liability arising from the company’s unlawful promotion of certain prescription drugs, its failure to report certain safety data, and its civil liability for alleged false price reporting practices, the Justice Department announced today. The resolution is the largest health care fraud settlement in U.S. history and the largest payment ever by a drug company.

GSK agreed to plead guilty to a three-count criminal information, including two counts of introducing misbranded drugs, Paxil and Wellbutrin, into interstate commerce; and one count of failing to report safety data about the drug Avandia to the Food and Drug Administration (FDA). Under the terms of the plea agreement, GSK will pay a total of $1 billion, including a criminal fine of $956,814,400 and forfeiture in the amount of $43,185,600. The criminal plea agreement also includes certain non-monetary compliance commitments and certifications by GSK’s U.S. president and board of directors. GSK’s guilty plea and sentence is not final until accepted by the U.S. District Court.

GSK will also pay $2 billion to resolve its civil liabilities with the federal government under the False Claims Act, as well as the states. The civil settlement resolves claims relating to Paxil, Wellbutrin, and Avandia, as well as additional drugs, and also resolves pricing fraud allegations.

“Today’s multi-billion-dollar settlement is unprecedented in both size and scope. It underscores the administration’s firm commitment to protecting the American people and holding accountable those who commit health care fraud,” said James M. Cole, Deputy Attorney General. “At every level, we are determined to stop practices that jeopardize patients’ health, harm taxpayers, and violate the public trust—and this historic action is a clear warning to any company that chooses to break the law.”

“Today’s historic settlement is a major milestone in our efforts to stamp out health care fraud,” said Bill Corr, Deputy Secretary of the Department of Health and Human Services (HHS). “For a long time, our health care system had been a target for cheaters who thought they could make an easy profit at the expense of public safety, taxpayers, and the millions of Americans who depend on programs like Medicare and Medicaid. But thanks to strong enforcement actions like those we have announced today, that equation is rapidly changing.”

This resolution marks the culmination of an extensive investigation by special agents from HHS-OIG, FDA, and FBI, along with law enforcement partners across the federal government. Moving forward, GSK will be subject to stringent requirements under its corporate integrity agreement with HHS-OIG; this agreement is designed to increase accountability and transparency and prevent future fraud and abuse. Effective law enforcement partnerships and fraud prevention are hallmarks of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which fosters government collaboration to fight fraud.

Criminal Plea Agreement

Under the provisions of the Food, Drug, and Cosmetic Act, a company in its application to the FDA must specify each intended use of a drug. After the FDA approves the product as safe and effective for a specified use, a company’s promotional activities must be limited to the intended uses that FDA approved. In fact, promotion by the manufacturer for other uses—known as “off-label uses”—renders the product “misbranded.”

Paxil: In the criminal information, the government alleges that, from April 1998 to August 2003, GSK unlawfully promoted Paxil for treating depression in patients under age 18, even though the FDA has never approved it for pediatric use. The United States alleges that, among other things, GSK participated in preparing, publishing, and distributing a misleading medical journal article that misreported that a clinical trial of Paxil demonstrated efficacy in the treatment of depression in patients under age 18, when the study failed to demonstrate efficacy. At the same time, the United States alleges, GSK did not make available data from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18. The United States further alleges that GSK sponsored dinner programs, lunch programs, spa programs and similar activities to promote the use of Paxil in children and adolescents. GSK paid a speaker to talk to an audience of doctors and paid for the meal or spa treatment for the doctors who attended. Since 2004, Paxil, like other antidepressants, included on its label a “black box warning” stating that antidepressants may increase the risk of suicidal thinking and behavior in short-term studies in patients under age 18. GSK agreed to plead guilty to misbranding Paxil in that its labeling was false and misleading regarding the use of Paxil for patients under 18.

Wellbutrin: The United States also alleges that, from January 1999 to December 2003, GSK promoted Wellbutrin, approved at that time only for major depressive disorder, for weight loss, the treatment of sexual dysfunction, substance addictions, and attention deficit hyperactivity disorder, among other off-label uses. The United States contends that GSK paid millions of dollars to doctors to speak at and attend meetings, sometimes at lavish resorts, at which the off-label uses of Wellbutrin were routinely promoted and also used sales representatives, sham advisory boards, and supposedly independent Continuing Medical Education (CME) programs to promote Wllbutrin for these unapproved uses. GSK has agreed to plead guilty to misbranding Wellbutrin in that its labeling did not bear adequate directions for these off-label uses.

For the Paxil and Wellbutrin misbranding offenses, GSK has agreed to pay a criminal fine and forfeiture of $757,387,200.

Avandia: The United States alleges that, between 2001 and 2007, GSK failed to include certain safety data about Avandia, a diabetes drug, in reports to the FDA that are meant to allow the FDA to determine if a drug continues to be safe for its approved indications and to spot drug safety trends. The missing information included data regarding certain post-marketing studies, as well as data regarding two studies undertaken in response to European regulators’ concerns about the cardiovascular safety of Avandia. Since 2007, the FDA has added two black box warnings to the Avandia label to alert physicians about the potential increased risk of congestive heart failure and myocardial infarction (heart attack). GSK has agreed to plead guilty to failing to report data to the FDA and has agreed to pay a criminal fine in the amount of $242,612,800 for its unlawful conduct concerning Avandia.

“This case demonstrates our continuing commitment to ensuring that the messages provided by drug manufacturers to physicians and patients are true and accurate and that decisions as to what drugs are prescribed to sick patients are based on best medical judgments, not false and misleading claims or improper financial inducements,” said Carmen Ortiz, U.S. Attorney for the District of Massachusetts.

“Patients rely on their physicians to prescribe the drugs they need,” said John Walsh, U.S. Attorney for Colorado. “The pharmaceutical industries’ drive for profits can distort the information provided to physicians concerning drugs. This case will help to ensure that your physician will make prescribing decisions based on good science and not on misinformation, money, or favors provided by the pharmaceutical industry.”

Civil Settlement Agreement

As part of this global resolution, GSK has agreed to resolve its civil liability for the following alleged conduct: (1) promoting the drugs Paxil, Wellbutrin, Advair, Lamictal, and Zofran for off-label, non-covered uses and paying kickbacks to physicians to prescribe those drugs as well as the drugs Imitrex, Lotronex, Flovent, and Valtrex; (2) making false and misleading statements concerning the safety of Avandia; and (3) reporting false best prices and underpaying rebates owed under the Medicaid Drug Rebate Program.

Off-Label Promotion and Kickbacks: The civil settlement resolves claims set forth in a complaint filed by the United States alleging that, in addition to promoting the drugs Paxil and Wellbutrin for unapproved, non-covered uses, GSK also promoted its asthma drug, Advair, for first-line therapy for mild asthma patients even though it was not approved or medically appropriate under these circumstances. GSK also promoted Advair for chronic obstructive pulmonary disease with misleading claims as to the relevant treatment guidelines. The civil settlement also resolves allegations that GSK promoted Lamictal, an anti-epileptic medication, for off-label, non-covered psychiatric uses, neuropathic pain, and pain management. It further resolves allegations that GSK promoted certain forms of Zofran, approved only for post-operative nausea, for the treatment of morning sickness in pregnant women. It also includes allegations that GSK paid kickbacks to health care professionals to induce them to promote and prescribe these drugs as well as the drugs Imitrex, Lotronex, Flovent, and Valtrex. The United States alleges that this conduct caused false claims to be submitted to federal health care programs.

GSK has agreed to pay $1.043 billion relating to false claims arising from this alleged conduct. The federal share of this settlement is $832 million and the state share is $210 million.

This off-label civil settlement resolves four lawsuits pending in federal court in the District of Massachusetts under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery.

Avandia: In its civil settlement agreement, the United States alleges that GSK promoted Avandia to physicians and other health care providers with false and misleading representations about Avandia’s safety profile, causing false claims to be submitted to federal health care programs. Specifically, the United States alleges that GSK stated that Avandia had a positive cholesterol profile despite having no well-controlled studies to support that message. The United States also alleges that the company sponsored programs suggesting cardiovascular benefits from Avandia therapy despite warnings on the FDA-approved label regarding cardiovascular risks. GSK has agreed to pay $657 million relating to false claims arising from misrepresentations about Avandia. The federal share of this settlement is $508 million and the state share is $149 million.

Price Reporting: GSK is also resolving allegations that, between 1994 and 2003, GSK and its corporate predecessors reported false drug prices, which resulted in GSK’s underpaying rebates owed under the Medicaid Drug Rebate Program. By law, GSK was required to report the lowest, or “best” price that it charged its customers and to pay quarterly rebates to the states based on those reported prices. When drugs are sold to purchasers in contingent arrangements known as “bundles,” the discounts offered for the bundled drugs must be reallocated across all products in the bundle proportionate to the dollar value of the units sold. The United States alleges that GSK had bundled sales arrangements that included steep discounts known as “nominal” pricing and yet failed to take such contingent arrangements into account when calculating and reporting its best prices to the Department of Health and Human Services. Had it done so, the effective prices on certain drugs would have been different, and, in some instances, triggered a new, lower best price than what GSK reported. As a result, GSK underpaid rebates due to Medicaid and overcharged certain Public Health Service entities for its drugs, the United States contends. GSK has agreed to pay $300 million to resolve these allegations, including $160,972,069 to the federal government, $118,792,931 to the states, and $20,235,000 to certain Public Health Service entities who paid inflated prices for the drugs at issue.

Except to the extent that GSK has agreed to plead guilty to the three-count criminal information, the claims settled by these agreements are allegations only, and there has been no determination of liability.

“This landmark settlement demonstrates the department’s commitment to protecting the American public against illegal conduct and fraud by pharmaceutical companies,” said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department’s Civil Division. “Doctors need truthful, fair, balanced information when deciding whether the benefits of a drug outweigh its safety risks. By the same token, the FDA needs all necessary safety-related information to identify safety trends and to determine whether a drug is safe and effective. Unlawful promotion of drugs for unapproved uses and failing to report adverse drug experiences to the FDA can tip the balance of those important decisions, and the Justice Department will not tolerate attempts by those who seek to corrupt our health care system in this way.”

Non-Monetary Provisions and Corporate Integrity Agreement

In addition to the criminal and civil resolutions, GSK has executed a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). The plea agreement and CIA include novel provisions that require that GSK implement and/or maintain major changes to the way it does business, including changing the way its sales force is compensated to remove compensation based on sales goals for territories, one of the driving forces behind much of the conduct at issue in this matter. Under the CIA, GSK is required to change its executive compensation program to permit the company to recoup annual bonuses and long-term incentives from covered executives if they, or their subordinates, engage in significant misconduct. GSK may recoup funds from executives who are current employees and those who have left the company. Among other things, the CIA also requires GSK to implement and maintain transparency in its research practices and publication policies and to follow specified policies in its contracts with various health care payors.

“Our five-year integrity agreement with GlaxoSmithKline requires individual accountability of its board and executives,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “For example, company executives may have to forfeit annual bonuses if they or their subordinates engage in significant misconduct, and sales agents are now being paid based on quality of service rather than sales targets.”

“The FDA Office of Criminal Investigations will aggressively pursue pharmaceutical companies that choose to put profits before the public’s health,” said Deborah M. Autor, Esq., Deputy Commissioner for Global Regulatory Operations and Policy, U.S. Food and Drug Administration. “We will continue to work with the Justice Department and our law enforcement counterparts to target companies that disregard the protections of the drug approval process by promoting drugs for uses when they have not been proven to be safe and effective for those uses and that fail to report required drug safety information to the FDA.”

“The record settlement obtained by the multi-agency investigative team shows not only the importance of working with our partners but also the importance of the public providing their knowledge of suspect schemes to the government,” said Kevin Perkins, Acting Executive Assistant Director of the FBI’s Criminal, Cyber, Response, and Services Branch. “Together, we will continue to bring to justice those engaged in illegal schemes that threaten the safety of prescription drugs and other critical elements of our nation’s healthcare system.”

“Federal employees deserve health care providers and suppliers, including drug manufacturers, that meet the highest standards of ethical and professional behavior,” said Patrick E. McFarland, Inspector General of the U.S. Office of Personnel Management. “Today’s settlement reminds the pharmaceutical industry that they must observe those standards and reflects the commitment of federal law enforcement organizations to pursue improper and illegal conduct that places health care consumers at risk.”

“Today’s announcement illustrates the efforts of VA-OIG and its law enforcement partners in ensuring the integrity of the medical care provided our nation’s veterans by the Department of Veterans Affairs,” said George J. Opfer, Inspector General of the Department of Veterans Affairs. “The monetary recoveries realized by VA in this settlement will directly benefit VA healthcare programs that provide for veterans’ continued care.”

“This settlement sends a clear message that taking advantage of federal health care programs has substantial consequences for those who try,” said Rafael A. Medina, Special Agent in Charge of the Northeast Area Office of Inspector General for the U.S. Postal Service. “The U.S. Postal Service pays more than one billion dollars a year in workers’ compensation benefits and our office is committed to pursuing those individuals or entities whose fraudulent acts continue to unfairly add to that cost.”

A Multilateral Effort

The criminal case is being prosecuted by the U.S. Attorney’s Office for the District of Massachusetts and the Civil Division’s Consumer Protection Branch. The civil settlement was reached by the U.S. Attorney’s Office for the District of Massachusetts, the U.S. Attorney’s Office for the District of Colorado, and the Civil Division’s Commercial Litigation Branch. Assistance was provided by the HHS Office of Counsel to the Inspector General, Office of the General Counsel-CMS Division, and FDA’s Office of Chief Counsel, as well as the National Association of Medicaid Fraud Control Units.

This matter was investigated by agents from the HHS-OIG; the FDA’s Office of Criminal Investigations; the Defense Criminal Investigative Service of the Department of Defense; the Office of the Inspector General for the Office of Personnel Management; the Department of Veterans Affairs; the Department of Labor; TRICARE Program Integrity; the Office of Inspector General for the U.S. Postal Service; and the FBI.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Kathleen Sebelius, Secretary of HHS. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. Over the last three years, the department has recovered a total of more than $10.2 billion in settlements, judgments, fines, restitution, and forfeiture in health care fraud matters pursued under the False Claims Act and the Food, Drug and Cosmetic Act.

Court documents related to today’s settlement can be viewed online at www.justice.gov/opa/gsk-docs.html.

Full Article and Source:
FBI: GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

See Also:
Drug giant GlaxoSmithKline to pay $35 million to Massachusetts Medicaid ...

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Ohio to get $40 million from health-care fraud settlement

HHS Grants to Help Protect Seniors, Test Elder Abuse Strategies

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a $5.5 million funding opportunity for states and tribes to test ways to prevent elder abuse, neglect and exploitation. This initiative helps to implement the Elder Justice Act, which was enacted as part of the Affordable Care Act. Secretary Sebelius made the announcement at a White House World Elder Abuse Awareness Day commemoration. The event brings together the public and private sector to address elder abuse issues.

“We need to be on the look-out for elder abuse and act when we see it,” said Secretary Sebelius. “Today we are sending a clear message that elder abuse will not be tolerated or kept in the shadows.”

Elder abuse is more common than generally believed, the Secretary noted, yet it often goes undiagnosed and unaddressed. Each year, millions of elderly Americans are assaulted, demeaned, intimidated, left without adequate food or care, or robbed of their life savings; yet, research suggests that elder abuse is significantly unreported.

Secretary Sebelius also announced that she will convene the first Elder Justice Coordinating Council meeting, as called for in the Elder Justice Act enacted as part of the health care law. The council, comprised of federal agencies that have responsibilities or programs related to elder abuse, neglect, and exploitation, will work to address the cross-agency coordination of activities relating to elder abuse, neglect and exploitation.

Full Article and Source:
HHS Grants to Help Protect Seniors, Test Elder Abuse Strategies