Does the failure by a health and rehabilitation center to provide safeguards to prevent a resident from leaving the facility unsupervised, followed by errors regarding his treatment that resulted in the resident’s death constitute fraud, waste and abuse that might result in the facility filing a false claim due to providing sub-standard quality of care?
Compliance Perspective – Resident Death:
The Compliance and Ethics Officer will review with the DON, Maintenance Manager and Administrator the facility’s policies and procedures regarding safeguards and protocols for preventing residents from wandering from the building unsupervised. Also, they will review the facility’s protocol for providing comprehensive assessments of a resident after a significant event like returning from the hospital after an incident. Staff should be educated and trained to recognize and redirect residents who are not to leave the facility unsupervised, and to observe and report changes in behavior. Training should also include the requirement to perform comprehensive assessments for residents who have experienced a change, trauma or an incident. Such assessments should consider whether the resident needs to be more closely monitored, e.g., for a 24-hour period. An audit of the facility’s exits and entrances should be conducted to determine if there are adequate safeguards in place, e.g., locked doors and alarms to prevent residents from leaving the facility unsupervised. Another audit should evaluate all residents for changes in their condition or behavior that might indicate the need to re-evaluate their assessments and care plans. The results of these audits will be summarized and submitted to the QAPI/QAA Committee for their review and recommendations.
The estate of a resident filed a lawsuit against a Wisconsin health and rehabilitation center in August 2017, claiming negligence in his 2016 death. The resident, after wandering from the facility, was found lying on the facility’s parking lot, taken to the hospital and then discharged back to the nursing home where he died that same afternoon.
The suit was recently settled through mediation, but for a much lower amount than was sought due to the complexities involved with the organization owning a group of 65 long-term care facilities entering receivership in July 2017. There was also a limited amount of insurance funds ($3 million)
available to settle this suit and 21 other personal injury claims.
The Centers for Medicare and Medicaid Services (CMS) initially fined the facility $552,000 following the resident’s death, but later reduced the fine to $363,000. The surveyors from the Wisconsin Department of Social and Health Services “found that the facility had few safeguards in place to prevent the residents from leaving the facility unsupervised and made errors when treating the resident after he returned from the hospital.”
The mediated agreements were made confidential and the families all agreed not to comment about them. As a result of the agreement the family’s lawsuit was dismissed in the Superior Court.
