Failure of Care Cases
In addition to the financial scam cases described above, the department has also dedicated significant resources to pursuing nursing homes that failed to provide Medicare and Medicaid beneficiaries with the health care services to which they were entitled and for which those programs paid. In May 2015, for example, the department resolved a matter against the owners and operators of two nursing homes in Watsonville, California. In that matter, the department alleged in its complaint that, between 2007 and 2012, the nursing facilities persistently overmedicated elderly and vulnerable residents, thereby causing infection, sepsis, malnutrition, dehydration, falls, fractures, pressure ulcers and for some residents, premature death. In addition to paying $3.8 million, the facilities entered into a five-year Corporate Integrity Agreement (CIA) with the Office of Inspector General of the Department of Health and Human Services (HHS/OIG).
Similarly, in October 2014, the department reached a $38 million settlement with Extendicare Health Services, one of the nation’s largest nursing home chains, to resolve False Claims Act allegations that the company had billed Medicare and Medicaid for grossly substandard services. The department led that nationwide investigation and worked closely with Medicaid Fraud Control Units and HHS-OIG, which negotiated a five-year CIA with that chain.
Finally, a criminal prosecution in my own district broke new ground in 2012 by successfully convicting a nursing home operator of criminal health care fraud on a “failure of care” theory. This defendant, George Houser, accepted $32.9 million in Medicare and Medicaid funds while the operation of his three nursing homes exhibited a long-term pattern and practice of inhumane living conditions for the residents—who often went without food, medical care and other needed services. Indeed, the judge at sentencing described the conditions at the nursing home as “barbaric, inhumane and uncivilized,” and sentenced Houser to 20 years in prison.
Building off this model of federal-state coordination, on March 30, the department launched 10 regional Elder Justice Task Forces. These multidisciplinary teams, which were chosen primarily based on their expertise in nursing home cases, will bring together federal, state and local prosecutors, law enforcement, victim service agencies and others in order to more quickly and effectively intercede against nursing homes that are failing to meet their obligations. In addition to my office in Atlanta, Elder Justice Task Forces were launched in the Northern District of California, Northern District of Georgia, Northern District of Iowa, District of Kansas, Western District of Kentucky, District of Maryland, Southern District of Ohio, Eastern District of Pennsylvania, Middle District of Tennessee and the Western District of Washington.
In addition to focusing on nursing home cases, Elder Justice Task Forces will pursue allegations of elder financial exploitation and other, related elder issues that may arise within the respective districts. The Elder Justice Task Force for the Northern District of Iowa, for example, will be continuing to combat elder financial fraud, like lottery and sweepstakes scams, as well as investigating allegations of nursing home providing grossly substandard care to their residents. See http://www.kcrg.com/content/news/Elder-Justice-Task-Force-formed-to-protect-elderly-Iowans-from-financial-fraud-383662701.html[external link].
