New Database Allows Consumers to Evaluate Nursing Homes Across the Country

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Consumers have a new online tool to see which nursing homes are being hit with fines for poor quality, safety or maintenance. Nursing Home Inspect 2.0 is a free database that assists users in evaluating nursing homes across the country. The database was first introduced by ProPublica, a nonprofit investigative news organization, in August 2012. On December 17, 2012, the same organization introduced the 2.0 version that includes information about federal fines imposed on nursing homes in the past three years.

The website can be found at Propublica.org/nursinghomes.

According to the website, the information provided comes from government inspection reports from the Centers for Medicare and Medicaid Services (CMS).

Fines Against Nursing Homes are Handed Out Inconsistently.

On the front page the website shows colored maps of the United States. The maps break down each state’s number of deficiencies and average fine amount. From a quick glance at the maps you can see states have imposed federal fines inconsistently.

In an interview with the Orlando Sentinel, an analyst who helped develop the website said nursing homes in some states pay a steep price for misconduct, while those in neighboring states don’t. An example used in the article shows that the average fine paid by a nursing home in South Carolina in the past three years is $40,507. The average fine in Texas is $6,933. Florida sits in the middle nationally, with an average fine of a little more than $17,000.

Click here to read the article from the Orlando Sentinel.

Nursing Homes Under the Watchful Eye of the Government.

Recently the Office of the Inspector General (OIG) Department of Health and Human Services (HHS) released its annual Work Plan.  This Work Plan is an overview of how the OIG intends to carry out its mission to make the Medicare and Medicaid programs run more smoothly and efficiently.

Of particular importance to Medicare and Medicaid providers is the Work Plan’s detailing of particular areas and billing codes and practices that will be under additional scrutiny during the 2012-2013 fiscal year. Nursing Homes are on the list due to the large source of abuse of federal healthcare dollars.

To learn about several key areas in nursing homes that will be under additional scrutiny, click here.

Contact Health Law Attorneys Experienced with Nursing Home Cases.

The Health Law Firm and its attorneys represent nursing homes and nursing home employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Would you use this new database? Do you think the way states and the CMS fine nursing homes across the country is fair ? Please leave any thoughtful comments below.

Sources:

Jameson, Marne. “New nursing home inspection website helps consumers make choices.” Orlando Sentinel. (December 17, 2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-nursing-home-inspection-website-20121217,0,171167.story

Lade, Diane. “Consumers Can Search Nursing Home’s Fines.” Sun Sentinel. (December 18, 2012). From: http://www.sun-sentinel.com/health/fl-nursing-home-inspect-20121217,0,887722.story

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Settlement Reached in WellCare False Claims Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

WellCare Health Plans Inc.(WellCare) has reached a settlement in its False Claims Act case. WellCare will pay $137.5 million to the federal government and nine states to settle four lawsuits. The lawsuits alleged violations of the False Claims Act.

WellCare is based in Tampa, Florida. The company provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries across the United States.

WellCare Allegedly Submitted False Claims to Medicare and Medicaid Programs.

The lawsuits accused WellCare of submitting false claims to Medicare and Medicaid programs. WellCare allegedly falsely inflated the amount it claimed to be spending on medical care. Allegedly, this was done in order to avoid returning money to Medicaid and other programs in various states, including the Florida Medicaid program and Florida Healthy Kids program. WellCare also allegedly knowingly retained overpayments it had received from Florida Medicaid for infant care. Furthermore, WellCare allegedly falsified data that misrepresented the medical conditions of patients and the treatments they received.

Settlement Requires WellCare to Pay the United States and Nine Individual States.

WellCare’s settlement requires the company to pay the United States and nine individual states $137.5 million. The nine states are Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York, and Ohio. The settlement also requires WellCare to pay an additional $35 million if the company is sold or experiences a change in control within three years of the agreement.

Whistleblowers Will Also Share in Settlement.

The four lawsuits against WellCare were filed by whistleblowers under the qui tam provisions of the False Claims Act. The qui tam provisions allow individuals to file lawsuits on behalf of the United States and share in any recovery.

The whistleblower whose qui tam complaint initiated the government’s investigation will receive approximately $20.75 million. The other whistleblowers will share approximately $4.66 million and will also be entitled to receive an additional share of any contingency payment.

Contact Health Law Attorneys Experienced in False Claims Act Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Kutscher, Beth. “WellCare Agrees to Pay Over $137.5 Million in Settlement.” Modern Healthcare. (Apr. 3, 2012). From: http://www.modernhealthcare.com/article/20120403/NEWS/304039975#ixzz1yAklA7ru?trk=tynt

U.S. Department of Justice, Office of Public Affairs. “Florida-Based WellCcare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations.” U.S. Department of Justice. (Apr. 3, 2012). From: http://www.justice.gov/opa/pr/2012/April/12-civ-425.html

Voreacos, David. “WellCare to Pay $137.5 Million to Settle False Claims Case.” Bloomberg News. (Apr. 3, 2012). From: http://www.bloomberg.com/news/2012-04-03/wellcare-to-pay-137-5-million-to-settle-false-claims-case-1-.html

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Florida HB 0653 Signed Into Law; Effective 2/1/2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Florida Legislature unanimously passed HB 653 which relaxes some of the draconian exclusions enacted under SB 1986, which went into effect on July 1, 2009. SB 1986, which added provisions to Chapter 456, Florida Statutes, among others, prevented numerous healthcare providers from obtaining or renewing licenses based on prior criminal convictions, which could have occurred decades earlier.

HB 653 has been passed unanimously by the Florida Legislature and has been signed by the Governor to be effective July 1, 2012. It has been signed into law as Chapter 2012-64, Florida Laws and amends Section 456.0635(5), Florida Statutes (2012).

Under HB 653, the professional boards within the Department of Health (such as the Board of Medicine, Board of Nursing, Board of Psychology, Board of Massage Therapy, etc.) now will, if signed by the Governor, only prohibit the renewal or granting of a health professional’s license, certificate or registration, if the individual:

1. Has been convicted of, or entered a plea of guilty or no contest to, regardless of adjudication, a felony under Chapters 409 (Medicaid offenses), 817 (theft or fraud) or 893 (drug offenses), Florida Statutes, or similar laws in other jurisdictions, unless the individual successfully completed a drug court program for the felony and provides proof that the plea was withdrawn or the charges were dismissed, or unless the sentence and any related period of probation for such conviction or plea ended:

- For first and second degree felonies, more than fifteen (15) years before the date of application;

- For third degree felonies, more than ten (10) years before the date of application, except for third degree felonies under Section 893.13(6)(a), Florida Statutes; and

- For third degree felonies under Section 893.13(6)(a), Florida Statutes, more than five (5) years before the date of application.

2. Has been convicted of, or entered a plea of guilty or no contest to, regardless of adjudication, a felony under 21 U.S.C. Sections 801-970 or 42 U.S.C. Sections 1395-1396 (federal Medicare & Medicaid offenses), unless the sentence and any subsequent period of probation for such convictions or plea ended more than fifteen (15) years before the date of application; or

3. Is listed on the OIG’s list of excluded individuals and entities.

This new legislation has the effect of reducing the period of time a health professional may be prohibited from holding a license because of a conviction for one of the enumerated felonies. Under the current law, there is a fifteen (15) year prohibition for all enumerated offenses. The new legislation, if signed, will reduce the period to as little as five (5) years for drug offenses.

However, it also broadens the reach of the current Florida law by including, for the first time, convictions under “similar laws in other jurisdictions.” This may now “catch” many to whom the Florida law did not previously apply.

HB 653 also allows individuals previously denied renewals under SB 1986 who at are now eligible for renewal to obtain a license without retaking and passing their examinations.

The latter requirement above, number 3, may present a “catch 22″ for many health professionals. Usually, if a licensed health professional is convicted of a felony, loses his/her license or is denied renewal of a health professional’s license, this is reported to the National Practitioner Data Bank (NPDB). The NPDB now includes reports previously made to the Healthcare Integrity and Protection Data Bank (HIPDB). If this occurs, in most cases the Office of Inspector General (OIG) commences action to exclude the professional from the Medicare Program. This automatically places the health provider’s name on the OIG’s List of Excluded Individuals and Entities (LEIE). Therefore, most licensed health professionals, even if they are no longer prohibited from holding a license under numbers 1 and 2 above, may still be prohibited because of requirement number 3 above.

Doubtless, this lacuna (gap) in this legislation will require additional corrective legislation in the future.

To view a summary of HB 653, click here.

To view the Bill Analysis of HB 653 from the Health and Human Services Quality Subcommittee, click here.

To view the Bill Analysis of HB 653 from the Health Care Appropriations Subcommittee, click here.

To view the Bill Analysis of HB 653 from the Health and Human Services Committee, click here.

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.