Ten California based skilled nursing facilities (SNFs) have resolved allegations brought on by the California Attorney General (AG) resulting in a $3.25 million settlement. The SNFs are owned by a Tennessee company.
The March 2022 settlement resolves allegations that the SNFs failed to adequately notify and prepare residents for both transfers and discharges and misrepresented their quality of care to the public by reporting false information. This allegation includes over reporting the number of hours that nurses provided care to residents to the Centers for Medicare & Medicaid Services (CMS). Allegedly, this over reporting to CMS resulted in fraudulently increasing the facilities’ star ratings in some categories. These over inflated star ratings were used to attract prospective residents and their families. The alleged over-reporting of nursing hours violated the Unfair Competition Law and False Advertising Law.
The settlement requires the SNFs to:
· Stop engaging in the illegal practices that are alleged in the lawsuit
· Appoint a monitor to oversee compliance at one of the facilities
· Pay $2.4 million in civil penalties, $550,000 in costs, and $300,000 to the county Long Term Care Ombudsman.
Summer Stephan, District Attorney of San Diego County, stated, “This case demonstrates that we will hold senior living facilities accountable to follow the rules regarding proper notification before release or transfer of an elderly person in their care. Family members need to be able to count on their loved one being cared for, and the law will be followed.” Alameda County District Attorney Nancy O’Malley said, “My Office takes very seriously any allegations that skilled nursing facilities are either misrepresenting their quality of care or failing to follow the law related to patient discharges.”
Issue:
Nursing facilities are required to accurately report their daily nursing hours to CMS. The nursing hours per day per resident are a key component of a facility’s star rating evaluation, and are also used in some quality measure determination. The accurate reporting of these hours to CMS is essential to avoid allegations of fraud. Misrepresenting nursing hours per day can result in fines and other civil penalties. In F-Tags 622 Transfer and Discharge and 624 Orientation for Transfer or Discharge, CMS requires careful preparation before a resident is discharged or transferred from the facility. Failure to properly prepare can result in citations and other sanctions.
Discussion Points:
- Review your policies and procedures on reporting nursing hours to CMS and on transfer and discharge. Update as needed.
- Train appropriate staff on your policy for accurately reporting nursing hours to CMS by way of the Payroll Based Journal (PBJ) System. Also train staff that an appropriate discharge plan is to begin at the time of a person’s admission. Specific requirements from CMS are designed to ensure safe transfers or discharges occur. Document that these trainings occurred and file each signed document in the employee’s individual education file.
- Periodically audit nursing hours actually worked per resident per day and ensure that accurate hours are being reported to CMS. Audit transfers and discharges to determine that appropriate protocols were followed, and monitor transfers and discharges in real time for appropriateness of preparation and communication.
