Kentucky US Attorney Michael A. Bennett announced on June 20, 2023, that two nursing homes that filed federal lawsuits seeking injunctive relief against the United States in an effort to remain open, have dismissed their cases, agreed to shut down, and will pay a total of $1,026,409 in civil money penalties to the Centers for Medicare & Medicaid Services (CMS). Both nursing homes are in Louisville, Kentucky, and are owned by the same company.
The Kentucky Division of Health Care performed numerous surveys of the two facilities beginning in September 2022 and continuing through May 2023. These surveys found substantial noncompliance with Medicare rules and regulations. As noted in filings with the Court, in the case of Nursing Home 1, those surveys included the following findings, among others:
- Blood glucometers were repeatedly used on multiple patients without disinfecting the glucometers.
- A resident was left in an unheated room, on the floor with skin tears, covered in urine and feces, and ultimately died of hypothermia.
- There was rodent infestation, with rats and their droppings in plain view in various parts of the facility including resident rooms, and a resident was bitten by a rodent.
- Residents were left in soiled clothing and linens without appropriate checks from staff.
- Garbage cans were left in resident rooms and elsewhere overflowing with soiled adult briefs.
- Staff failed to implement care plans for multiple residents, each of whom later suffered serious harm.
- A March 2023 survey found that medications were improperly kept past expiration and improperly left unlocked.
- Personnel were hired despite disqualifying criminal convictions.
- Even though some deficiencies cited by Kentucky were corrected, the facility failed to be in substantial compliance even after a fourth revisit. Many resident rooms still had malfunctioning and nonfunctioning heating and cooling units, including one left pulled out of an exterior wall, allowing rodents to enter.
In the case of Nursing Home 2, filings with the Court showed that CMS surveys included the following findings, among others:
- Residents were not protected from abuse.
- Blood glucometers were used on multiple patients without disinfecting them properly between uses.
- Personnel files failed to show that complete and proper background checks had been performed on employees, with some employees having disqualifying events that proper background checks should have revealed.
- The facility failed to ensure that alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately.
- The facility failed to develop and implement care plan interventions for residents with physician’s orders for oxygen.
The federal lawsuits were filed by the two nursing homes in the United States District Court for the Western District of Kentucky on May 24, 2023. The United States filed motions to dismiss the lawsuits and sought to dissolve the temporary restraining orders initially entered by the Court. Following a brief hearing with the Court on June 1, 2023, the two nursing homes agreed to terminate their provider agreements with Medicare, dissolve the temporary restraining orders, dismiss their cases, with prejudice, and close their facilities within 30 days. As part of the closure process, they will be required to safely transfer Medicare and Medicaid residents in their respective facilities to other facilities and submit a comprehensive closure and relocation plan for each facility that is acceptable to CMS.
As a result of their noncompliance with federal rules and regulations, Nursing Home 1 will pay CMS a Civil Monetary Penalty of $636,752.75 and Nursing Home 2 will pay CMS a Civil Monetary Penalty of $389,656.25, for a combined total of $1,026,409.
Compliance Perspective
Issue
Nursing homes must meet all federal program requirements and provide their residents with the quality care and services they deserve. According to F842 in the State Operations Manual, Appendix PP, quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, facilities must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents’ choices. Residents’ rights for freedom from abuse, neglect, and exploitation must also be protected. Failure to meet these requirements may be viewed as substandard quality of care, which could result in immediate jeopardy citations for the facility with fines and other sanctions.
Discussion Points
- Review your policies, procedures, and staffing guidelines to ensure they are designed to result in provision of quality care for residents. Review your Facility Assessment as required by F838 to ensure it addresses the needs of all residents. Update your policies and Facility Assessment as necessary.
- Train staff on their responsibility to provide safe, high quality nursing care, or to provide support services that help meet resident needs. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure staff are following policies for delivering safe, quality nursing care and support services. Ensure your Facility Assessment is current, thoroughly assesses the needs of all residents, and determines the resources required to provide high quality resident care and services. Review your QAPI initiatives to ensure that safe, quality care is monitored as an initiative of the QAA/QAPI committee.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
