Federal Appeals Court Rules in Favor of Nursing Home Residents
in
“Patient Dumping” Lawsuit
After a lower court previously ruled in favor of the defendant nursing homes, the 9th U.S. Circuit Court of Appeals recently issued an opinion allowing the lawsuit against the California Department of Health Care Services and Department of Health and Human Services to move forward. The suit alleges that California regulators failed to “crack down on patient dumping by care facilities.”
The lawsuit was made on behalf of three former residents of two certified nursing homes by their attorneys and the California Advocates for Nursing Home Reform. One of the three plaintiffs is now deceased. The attorneys had argued that the three residents were targeted by the nursing homes because they were covered by Medi-Cal and not by the higher compensating Medicare or private insurance.
Frequently, what is happening to nursing home residents like these plaintiffs is a strong financial incentive to prefer Medicare or private insurance funded residents over those covered by Medi-cal. Consequently, some nursing homes engage in what has been termed “patient dumping” in which the nursing home sends a resident covered by Medi-Cal to a hospital for care and then refuses to readmit them when the hospital completes their care.
One of the plaintiffs had been in a nursing home for four years, and then was transferred to a hospital where he lived for one year before being placed in another nursing home. The second resident had a stroke and was making progress after six years, then was transferred to a hospital where his condition deteriorated. The third resident had amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease as it is commonly called. He spent two years in another California nursing home and was then sent to a hospital and later died.
Attorneys in the case expressed hope that the appeals court ruling will result in the state of California addressing the issue and helping people who find themselves in this situation.
Compliance Perspective
Transferring residents to a hospital for care with the intention of not readmitting them due to their lower payor source like Medicaid may be considered an infringement of residents’ rights to receive equal practices regardless of payment source and the provision of sub-standard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding residents’ rights regarding admission, transfer, readmission, and discharge.
- Train staff regarding residents’ rights to receive a high level of care no matter what their payment source.
- Periodically audit to determine if residents with Medicaid as their payor source are being “dumped” in order to allow the facility to accept residents on higher paying Medicare and private insurance.
