California’s Attorney General (AG) has joined District and City Attorneys in filing a lawsuit against a nursing home chain with ten nursing homes operating in California. The lawsuit alleges that the nursing homes ignored laws that protect patients’ safety when they are discharged from a facility. In addition, the lawsuit alleges that the nursing homes gave false information to the Centers for Medicare & Medicaid Services (CMS) in order to fraudulently increase their star rating in several categories.
The lawsuit alleges that the nursing homes failed to properly notify patients and their families of transfers and discharges 30 days in advance or as soon as practicable. The required notice was not given to the patients nor to the local ombudsmen. Also, the lawsuit alleges that the nursing homes failed to properly prepare the patients for transfer or discharge, which endangered the health of the patients and left families having to quickly find other places to care for their loved ones.
In addition, the lawsuit alleges that the nursing homes misrepresented the quality of their care to the public by reporting false information to CMS. Specifically, the lawsuit alleges that the nursing homes overreported nursing staffing hours to CMS, for which CMS awarded the nursing homes with undeserved four-and-five-star ratings. The lawsuit further argues that by engaging in these unfair business practices, the nursing homes violated both the Unfair Competition Law and the False Advertising Law.
Issue:
Every nursing facility must ensure that a resident’s discharge plan meets the needs of the resident and is safe. In the event of a facility-initiated discharge, an advance notice must be given to the resident, resident representative, and to the ombudsman. The advance notice timeframe should be either 30 days or as soon as practicable, depending on the reason for the discharge. Also, every attempt should be made to avoid submitting inaccurate direct resident care hours. Falsifying records to avoid quality of care requirements can result in substandard, dangerous conditions for nursing home residents, which may be seen as fraud, waste, and abuse of government funds.
Discussion Points:
- Review your policies and procedures for reporting direct care hours and for resident discharge to ensure they accurately incorporate CMS requirements. Update your policies as needed.
- Train all staff who have responsibility for collecting and reporting direct resident care hours on your policy and procedures to ensure they comply with requirements. Train all employees to only claim hours that they have actually worked, and that these must be captured accurately. Also train staff with resident discharge responsibilities to follow requirements for safe discharge, whether it is resident initiated or facility initiated. Document that these trainings occurred, and file each signed document in the employee’s education file.
- Periodically audit to ensure that direct resident care hours are recorded accurately, and that these hours are being reported correctly. Also, periodically audit to ensure that all discharged residents and/or their representatives were notified within appropriate time frames of the impending discharge and that all required steps were taken to ensure the discharge was safe.
