Massachusetts Attorney General (AG) Andrea Joy Campbell announced a $4 million settlement with a Woburn-based long-term care (LTC) management company that operates sixteen nursing homes in Massachusetts. The settlement, announced on June 10, 2024, is the largest nursing home settlement ever reached by the Massachusetts AG’s office, and resolves allegations that the company deliberately failed to properly staff the nursing homes it owned and operated, resulting in resident harm and neglect. As part of the settlement, most of the company’s facilities will be required to be overseen, at its own expense, by an independent compliance monitor.
The settlement follows a years-long investigation by the AG’s office, which investigated reports of substandard care or regulatory violations at the company’s nursing homes based on complaints and referrals received from the Department of Public Health (DPH).
The settlement resolves the AG’s office’s allegations that the company implemented staffing reductions in April 2019, despite its facilities already struggling to ensure adequate staffing levels to meet the needs of residents. Those staffing reductions included reductions of both certified nursing assistant (CNA) positions and non-CNA positions. The AG’s office alleged that the company implemented such reductions without consideration of resident needs.
The AG’s office further alleged that the company continued to understaff its facilities even after state regulations went into effect in April 2021 requiring certain staffing requirements. As a result, many of the company’s nursing facilities had staffing levels that ranked in the bottom 10 percent of their counties. The AG’s office alleged that the low staffing levels led to resident neglect and harm.
The AG’s office contends that the company’s submission of claims to MassHealth for these substandard services were false claims, in violation of the Massachusetts False Claims Act, and that this conduct also violated the Massachusetts Consumer Protection Act, and a state statute protecting elders from abuse and neglect in nursing homes.
Under the terms of the settlement agreement, the company agreed to budget staffing at state-mandated levels and pay an additional $4 million to resolve the allegations. $750,000 of those settlement funds will be paid to the Commonwealth, which will evenly distribute the amount to MassHealth and the Long-Term Care Facility Quality Improvement Fund, a DPH-operated fund that aims to improve the quality of care delivered to residents of LTC facilities. The remaining $3.25 million will be overseen by the independent compliance monitor and must be used for additional staffing improvements, recruitment, retention, additional benefit costs, bonuses, overtime, wage increases, and/or other staffing-related initiatives over the next three years.
In addition to the monetary penalties, the company has also agreed to hire, at its own expense, an independent compliance monitor, who will oversee the improvement of its staffing levels and ensure that its facilities comply with state staffing requirements. The compliance monitor will also be responsible for reviewing the quality of care delivered to residents at eight of the company’s facilities. As part of the settlement, the compliance monitor will conduct on-site reviews of the company’s facilities and will submit compliance reports to the AG’s office every six months.
Compliance Perspective
Issue
Facilities must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to ensure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity, and diagnoses of the facility’s resident population in accordance with the required facility assessment according to F838.
Discussion Points
- Review policies and procedures for sufficient staffing to meet the needs of the residents based on their individual acuity levels. Review policies and procedures on recruiting and retaining staff. Update your policies as needed.
- Train staff who are responsible for hiring to develop innovative and effective ways to recruit and retain staff. Train staff responsible for scheduling and distribution of available staff per unit to ensure that the facility’s staffing levels meet the needs of the residents, that this information is posted as required by regulation, and that staffing is secured on all shifts for this purpose. Document that these trainings occurred and file in each appropriate employee’s education file.
- Periodically audit to determine if the numbers of staff needed to meet the levels of acuity of all residents in the facility are being posted, and that those staffing requirements are actually being met on all shifts on a day-by-day basis.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
