December 6, 2021
While it is
axiomatic that a nursing home owner’s record is a good predictor of the quality
of care the owner will provide in the future in another facility, many poor
quality providers are expanding the numbers of facilities that they own or
operate. Why is this disturbing trend apparently increasing? Unfortunately,
there is no easy or simple answer to the question. In fact, there are likely
multiple inter-related explanations.
1.
Facilities use complex ownership structures, and deliberately so, to confuse
states and the public about who “owns” a nursing facility.
A 2003
article, “Protecting Nursing Home Companies: Limiting Liability Through
Corporate Restructuring,”[1]
explicitly recommends creating multiple companies – real estate, management,
staff, supplies, etc. – so that government agencies and people who have been
injured will not know which companies can and should be held accountable. The
authors write:
In the context
of nursing home ownership and operation, legal entities such as corporations,
limited liability companies, and limited liability partnerships can be formed
to benefit nursing home companies by limiting the financial liability and
Medicare and Medicaid exclusion exposure of the real-estate investors and
business owners. For example, the business entities that result from
restructuring can help a nursing home operator avoid unnecessary exclusion of
all Medicare and Medicaid providers currently owned by the same entity, in the
event that any one of them is excluded from the Medicare or Medicaid programs.
The business entities can also prevent litigants from obtaining judgments
against related companies, and the owners personally, in proceedings alleging
Medicare or Medicaid overpayments, false claims, or negligence.
The article
suggests that creation of multiple single-purpose entities can help companies
avoid both exclusion from the Medicare and Medicaid programs and financial
liability due to Medicare and Medicaid overpayments, the False Claims Act, and
malpractice/negligence litigation. Separating the real estate investment from
the nursing home operation is one specific recommendation.
State laws
have not caught up with these complex ownership devices. State rules for
ownership do not delve into the complex and inter-related systems that owners
devise.
2.
States do not know who is behind a corporation, particularly when the owners
create a new corporation with a new name to apply for a state license.
Corporations
have independent identities that are separate from the principals behind
them. There are multiple examples of owners exploiting this legal
principle to their advantage. Owners form new corporations with new
names, creating corporate entities that have no records. State laws appear to
treat these owners as “new” owners, if that is how they present themselves,
even when the owners actually had poor records using different corporate names.
In 1994, Jon
Robertson formed Phoenix Health Group and acquired nursing facilities in
California. The Los Angeles
Times reported in 1997, “As the money began to roll in from
Medicare and Medi-Cal payments to the more than 300 residents at the
facilities, Robertson, who had long displayed a fondness for life’s pricier
pleasures – from Harley-Davidson motorcycles to diamond rings – began to spend
conspicuously.”[2] In
1996, Robertson checked into a rehabilitation center in Phoenix to deal with a
cocaine addiction. Robertson also “served prison time and owed $150,000 in
restitution to the IRS for filing a false tax return as president of another
nursing home management company.”[3]
Robertson’s California facilities provided poor care for residents and were
cited with numerous deficiencies. The company filed for bankruptcy and abruptly
closed its facilities.
Later,
Robertson formed a new company, Utah-based Deseret Health Group. Despite
Robertson’s poor record, multiple states gave licenses to Robertson’s new
company and the federal government certified the facilities for Medicare and
Medicaid reimbursement. In May 2015, Deseret abruptly stopped paying for food,
medical supplies, and workers’ wages and benefits in at least seven nursing
facilities owned by the company in Kansas, Minnesota, Nebraska, and Wyoming.
States pursued court receiverships or otherwise took control of the facilities
in order to protect residents and ensure they received food and medications.[4]
A second
example occurred in Illinois in 2018, when William Rothner and Allied Health
Services, Inc. sought to purchase and convert to for-profit ownership the
Champaign County, Illinois county nursing facility. In August 2018, the County
Review Board asked the potential purchasers to identify any adverse actions
taken against them or any facilities owned or operated by them. A certification
signed by Rothner on August 15, 2018 indicated that no action had been taken
against University Rehabilitation Center of CU, LLC and University Rehab Real
Estate, LLC. However, neither University Rehabilitation Center of CU, LLC nor
University Rehab Real Estate, LLC existed on August 15. The companies listed on
the certification reflected the new name that the applicants intended to give
the county nursing facility once they bought it, but they were not created
until August 17, 2018.[5]
Clearly, no adverse actions could have been taken against companies that did
not actually exist.
Champaign
County Healthcare Consumers opposed the sale of the county nursing facility to
the for-profit owners[6]
and reported that multiple facilities owned by Rothner and Altitude Health
Services, Inc. in Illinois (and other states) had, in fact, had many
significant adverse actions filed against them.[7] Nevertheless, the County sold the facility
to Rothner, who took over in April 2019.[8]
3.
Owners use multiple names, concealing their actual ownership of nursing
facilities.
In the past,
nursing homes under common ownership would typically share a common corporate
name. Now many companies, and conglomerates of companies, buy facilities in
multiple states under multiple new names.
In 2020, Barron’s reported that
Portopiccolo, a private equity firm started in 2016, operates 100 facilities
under various names, such as Accordius, Pelican Health, and Orchid Cove.[9] The name Portopiccolo
may not appear on ownership papers or admissions contracts with residents. The Washington Post reported
in December 2020 that during the coronavirus pandemic, Portopiccolo Group,
despite its record of poor care (nearly 70 percent of Portopiccolo facilities
had ratings of one or two (of five) on the federal website), short staffing,
and coronavirus outbreaks, bought at least 22 nursing facilities, with “scant
scrutiny” from state regulators in Maryland and Virginia.[10]
Another
example comes from Vermont. SevenDaysVt
reported in July 2021 that three people were identified on loan
documents in the Fall 2020 as wanting to buy three nursing facilities in
Vermont that were owned by Genesis HealthCare. When the application for the
license was submitted to the state in February 2021, however, the wife of one
of the owners, Ephram Lahasky, was substituted for Lahasky because Lahasky had
a troubled history with nursing facilities in Pennsylvania.[11] Substituting Lahasky’s wife meant that
the purchasers were not required to identify the Pennsylvania facilities for
Vermont to review.
4.
State rules are largely about ownership and changes in ownership, but
facilities can be managed by different corporations, without state approval,
even while a change in ownership is pending or denied.
The State of
California has denied licenses to some potential buyers with poor records in
other facilities they own in the State. Despite being denied licenses, the
owners got control, and public reimbursement, as managers of those facilities.
The California
nursing home company ReNew Health is one example. Founded in 2014, ReNew Health
now owns or is affiliated with at least 26 nursing facilities in California,
with about 2,000 residents. In 2020, during the coronavirus pandemic, and after
the state moved to revoke the license of ReNew’s owner, Crystal Solorzano,
state regulators denied Solorzano’s request to take over nine additional
nursing facilities. Nevertheless, LAist
reports, “Due to what advocates say is a flawed licensing process, Solorzano is
allowed to run those nine nursing homes – and others across the state – as she
appeals the state health department’s decision.”[12] California law permits potential buyers
to operate facilities under management agreements as they appeal the denial of
a state license. Appeals take years.
The state’s
April 24, 2020 license denial letter for the nine additional California
facilities cites the March 20, 2020 revocation of Solorzano’s nursing home
administrator license because of unprofessional conduct, but notes that the
revocation is not in effect because of Solorzano’s appeal.[13] The April 24 letter recites that the
California Department of Public Health (CDPH) determined that Solorzano
“submitted fraudulent documents to obtain [her] nursing home administrator
license” – a fraudulent college transcript – in 2008. In addition, CDPH’s
review of the compliance history of facilities owned, managed, or operated by
Solorzano in the prior three years identified 14 immediate jeopardy
deficiencies, 29 harm-level deficiencies, and 85 level F deficiencies. The
letter describes the jeopardy deficiencies in detail (including rodent feces in
a kitchen, a resident’s pepper-spraying a roommate and stabbing another
resident, and a certified nurse assistant’s rape of a resident) as well as
three administrative penalties under state law for failing to comply with
minimum staffing levels.
LAist reports, “In its short
time caring for California’s most vulnerable – many of them elderly and
mentally ill – the company has racked up an inordinate number of red flags and
citations, many for infractions known as ‘Immediate Jeopardies.’”[14] Although providing
care to one in fifty California nursing home residents, ReNew Health has been
cited for nearly one in ten immediate jeopardy deficiencies in California. At
least 198 people have died from COVID-19 at ReNew Health nursing facilities.
The state of
California has also allowed Shlomo Rechnitz, the state’s largest nursing home
owner, and his companies (with at least 81 facilities in California with more
than 9,000 beds), to operate 18 nursing facilities (with more than 1700 beds)
without a state operating license since 2014, when Rechnitz purchased the
Country Villa chain through a bankruptcy auction. Then California Attorney
General Kamala Harris filed an emergency motion in the bankruptcy court,
opposing Rechnitz’s purchase of the Country Villa facilities and calling him
“‘a serial violator of rules within the skilled nursing industry.’”[15] CalMatters describes the
state’s licensing process as “opaque, confusing and rife with inconsistencies.”[16]
Although the
state has still not decided whether to give Rechnitz licenses to run the 18
nursing homes, a company attorney contends that the state has approved an
“‘interim management agreement’” for the company’s operations of the Country
Villa facilities. As CalMatters
reports, while new owners apply for change of ownership of a
facility, “the state allows new owners to operate homes using the license of
the previous owner.”[17]
In addition, management companies can run the day-to-day operations of
facilities.
In e-mails
with CalMatters,
the California Department of Public Health wrote that “the state considers
individual change-of-ownership applications on a case-by-case basis, and
reviews of applicants with larger portfolios or more complex organizational
structures take longer.”[18]
The state’s review considers “the applicant’s history of compliance with state
regulations.”[19]
However, applicants do not need state approval of a management company during
the change-of-ownership process.
Although the
Department told the State Auditor in 2018 that it was “‘developing regulations
to clarify’ the change-of-ownership application process,’” those efforts “have
been ‘placed on a temporary hold due to staff redirections associated with
COVID response.’”[20]
Like many
states, Vermont law authorizes state officials to review nursing home sales
“and block purchases by buyers who are financially or otherwise unfit.”[21] In the Fall of 2020,
two New Yorkers contracted with Genesis HealthCare to manage five Genesis
facilities in Vermont. As the state decides whether to give state
licenses to the new buyers of the Genesis facilities, the buyers continue to
manage the facilities.[22]
The
Texas-based PC Hayes Management company has owned Twin City Gardens, a
Minneapolis nursing facility, since October 2020. The Star Tribune reports that
the Texas company “has been unable to renew the facility’s license, which
expired at the end of September, because it cannot show proof of liability
insurance, according to [Minnesota Department of Health].”[23] Nevertheless, without a license,
the Texas management company continues to operate the Minneapolis nursing
facility.
According to
the federal website Care
Compare, as of October 27, 2021, the facility’s record under PC
Hayes Management is poor. Since January 2021, the facility has had five
complaint surveys, which have cited 12 deficiencies, including three immediate
jeopardy deficiencies and one actual harm deficiency (the highest two
categories of noncompliance, which are assigned to fewer than 5% of
deficiencies nationwide). It has more residents than the state average who are
administered antipsychotic drugs and it has been cited for abuse.
5.
Many owners are wealthy and make substantial campaign contributions to state
and federal elected officials, which gets them access and a friendly reception
to their policy goals and priorities.
In a
three-part series in 2017, “Profits over patients,” The Advocate
describes “a long list of financial policies and laws in Louisiana that heavily
favor nursing homes . . . a testament to the strength of the state’s nursing
home lobby, long a leading source of campaign cash for the state’s
politicians.”[24]
While most states have been shifting Medicaid payments away from nursing homes
and towards home and community-based services and spending, Louisiana is an
outlier and moving in the opposite direction.
Part 2, titled
“For Louisiana nursing homes, waves of campaign cash prompt favorable policy,”[25] documents the
campaign contributions of the nursing home industry that lead to policies favoring
the industry. The Advocate
reports that then-Governor Bobby Jindal abandoned a plan to reform the state’s
health care system (by moving to managed long-term care) when the nursing home
industry sent an e-mail objection. The plan had been developed over a two-year
period with the participation of nursing home representatives (who voiced their
objections outside of the meetings) and, it was estimated, would save $77
million annually in Louisiana’s long-term care costs.[26]
Part three –
“How lawmakers, politicians voted to enrich Louisiana nursing homes, instead of
saving money” – ties the first two parts of the series together, documenting
the state laws that benefit the nursing home industry. State laws “require the
state to increase biannually the daily rates they pay nursing homes – and make
those rates nearly impossible to cut.”[27]
An Editorial
in The Advocate describes
why nursing homes are so favored in the state Capitol: “The industry contributes
lavishly to political campaigns, virtually ensuring that when governors and
legislators decide how lucrative Medicaid dollars get spent, nursing home
operators stand at the head of the line.”[28]
A second
example of industry influence on state policy is Florida. Naples Daily News reported
in 2019 that Florida’s new Medicaid reimbursement, which was enacted in 2017
and will be fully implemented in 2023, will result in reduced reimbursement for
some of the state’s best performing facilities, while providing higher
reimbursement for some of the state’s most poorly performing facilities. The
newspaper’s analysis determined that one in four facilities averaging four to
five stars (five is the highest rating) will lose more than $15 million
combined under the new reimbursement system, while “On the flip side, 53
nursing homes that averaged two stars or fewer between 2013 and 2017 are
projected to receive more money, an additional $25 million combined.”[29]
Leaders of
non-profit facilities opposed the legislation in 2017, urging legislators “‘not
to put profits over people,” but, Naples
Daily News reports, the for-profit nursing home industry enjoyed
“Clout after contributions.”[30]
In addition to
affecting the Medicaid reimbursement system, Naples
Daily News reports the nursing home industry’s success in
“defeat[ing] measures intended to improve care and . . . pass[ing] legislation
that financially benefits . . . its members.”[31] Examples are the enactment of legislation
banning lawsuits against passive investors and stopping “an ‘unfriendly’ bill
that would have mandated a $1 million state penalty against nursing homes where
patients died from abuse or neglect.”[32]
6.
Owners become too big to regulate, too big to fail.
When a
corporation owns or manages a large portion of facilities in a state, the
corporation becomes “‘Too big to fail,’” says Charlene Harrington, professor of
nursing at the University of California, San Francisco.[33] If a state takes strong enforcement
action against a large owner, it has to consider what will happen to the
facilities and their residents. Since States do not have the resources to
operate facilities directly, they look for another company to operate the
facilities, temporarily or permanently, as quickly as possible.
When New
Jersey-based Skyline HealthCare collapsed in 2018 and abandoned nursing
facilities that it had taken over across the country in little more than a
year, multiple states installed temporary managers or rushed to court to get
receiverships so that staff and vendors would be paid and residents would have
food and medications. States were eager to transfer ownership of the facilities
to new owners, and in some instances, gave authority to companies they knew
very little about.
An example
occurred in Pennsylvania. The state identified as the new operator of the
Skyline facility in Lancaster a new for-profit company that had been created on
May 2, 2018, the same day that temporary management over the Pennsylvania
Skyline facilities was installed. The effective date of the sale of the
Lancaster facility was May 14. The new operator was not actually new, however.
According to Lancasteronline,
the new company had at least two of the same owners and shared the address of a
company, Priority Healthcare Group, that had actually bought 14 facilities in
the state in 2016.[34]
Priority’s record managing 11 former Golden Living facilities in Pennsylvania
was poor; Priority cut staffing levels and reduced other spending at the
facilities.[35] Yet
this newly created company was entrusted with a former Skyline facility.
Through the
HHS Office of Inspector General, the federal government has authority to
exclude providers from the Medicare and Medicaid programs.[36] It uses this mechanism for individuals
and sometimes, for small companies, like a small home health agency. It does
not use this authority against large companies because of the difficulty of
operating hundreds of facilities in multiple states. Instead, the Inspector
General typically enters five-year Corporate Integrity Agreements[37] with large companies[38] and even with
individual nursing facilities.[39]
The companies are too big for the government to use its strongest enforcement
tool.
7.
Federal government does no oversight of ownership or management of facilities
that it certifies for reimbursement.
As long as a
facility is licensed by the state and provides information to CMS about who has
ownership interests in the facility, the federal government will certify the
facility for Medicare and Medicaid. The federal government does not conduct an
independent investigation or make an independent determination about
facilities’ ownership, management, or financial capacity to operate nursing
facilities.
Conclusion
Who owns or
operates a nursing facility largely determines whether the facility will
provide good care to its residents. While individuals and companies can
purchase facilities and buildings, they are not automatically entitled to state
licenses and federal certification.
Multiple
actions at the state and federal levels are needed to ensure that owners and
managers are qualified and competent and have sufficient financial resources
and management skills to operate nursing facilities. States must fully enforce
existing laws and enact (and fully enforce) additional provisions to ensure
that applicants for licenses disclose audited ownership and financial
information about all related parties. The federal government needs to take an
active role in overseeing who is eligible for the billions of dollars in
federal reimbursement that nursing homes receive.
T. Edelman
___________________
[1] Joseph E. Casson,
Julia McMillen, “Protecting Nursing Home Companies: Limiting Liability Through
Corporate Restructuring,” Journal of Health Law, Vol. 36, No. 4 (Fall 2003), http://briuswatch.org/wp-content/uploads/2016/06/Casson-J.-Protecting-Nursing-Home-Companies-2003.pdf
[2] Eric Slater, “Entrepreneur Fades From View
as Empire Collapses,” Los
Angeles Times (Oct. 23, 1997), https://www.latimes.com/archives/la-xpm-1997-oct-23-mn-45876-story.html
[3] The Associated Press, “Utah company facing
bankruptcy; nursing home residents in limbo,” The Salt Lake Tribune (May 13, 2015)
[4] See, e.g., H.B. Lawson, “Nursing home
faces closure,” The Saratoga
Sun (May 6, 2015), https://www.saratogasun.com/story/2015/05/06/news/nursing-home-faces-closure/3898.html
[5] Champaign County Health Care Consumers
(CCHCC), “Research on bidder for Champaign County Nursing Homes” (May 21,
2018), https://www.healthcareconsumers.org/research-on-bidder-for-champaign-county-nursing-home/;
CCHCC, “Champaign County Nursing Home will not be owned by the companies
approved by the County Board” (Oct. 29, 3018), https://www.healthcareconsumers.org/champaign-county-nursing-home-will-not-be-owned-by-the-companies-approved-by-the-county-board/;
Jim Meadows, “Watchdog Group Says Applicant To Buy County Nursing Home Switched
Companies,” willradio.tv.online
(NPR) (Oct. 29, 2018), https://will.illinois.edu/news/story/watchdog-group-says-applicant-to-buy-county-nursing-home-switched-companies
[6] Letter to Vice Chair Richard Sewell,
Illinois Health Facilities and Services Review Board, from CCHC re Project
Number 18-026 Champaign County Nursing Home, Urbana (Oct. 22, 2018), https://www2.illinois.gov/sites/hfsrb/Projects/ProjectDocuments/2018/18-026/2018-10-22%2018-036%20Response%20to%20SAR.pdf
[7] CCHCC, “Research on bidder for Champaign
County Nursing” (May 21, 2018), https://www.healthcareconsumers.org/research-on-bidder-for-champaign-county-nursing-home/
[8] As reported in CMA, “Privatization of
County-Owned Nursing Facilities is Not Good for Residents, Staff, and States”
(Special Report, Oct. 20, 2021), https://medicareadvocacy.org/wp-content/uploads/2021/10/CMA-Report-SNF-Privatization-10-2022.pdf,
the facility quickly became a Special Focus Facility. As of October 5,
2021, the federal website Care
Compare does not report staffing information for the facility and
resident and staff vaccination rates.
[9] Eleanor Laise, “As the Pandemic Struck, a
Private-Equity Firm Went on a Nursing –Home Buying Spree,” Barron’s (Aug. 6,
2020), https://www.barrons.com/articles/as-the-pandemic-struck-a-private-equity-firm-went-on-a-nursing-home-buying-spree-51596723053?mod=hp_DAY_Theme_1_1
[10] Rebecca Tan and
Rachel Chason, “An investment firm snapped up nursing homes during the
pandemic. Employees say care suffered,” The
Washington Post (Dec. 22, 2020), https://www.washingtonpost.com/local/portopiccolo-nursing-homes-maryland/2020/12/21/a1ffb2a6-292b-11eb-9b14-ad872157ebc9_story.html
[11] Daniel
Simmons-Ritchie, “Still Failing the Frail; New Name, Same Nightmare,” Patriot-News (Nov. 15,
2018), https://www.pennlive.com/news/2018/11/pennlive-special-investigation-still-failing-the-frail.html
[12] Elly Yu and Aaron
Mendelson, “Immediate Jeopardy: Death And Neglect Inside A Troubled California
Nursing Home Chain,” LAist
(Apr. 6, 2021), https://laist.com/special-reports/nursing-homes-renew.php
[13] Letter from T.
Scott Vivona, Assistant Deputy Director, Center for Health Care Quality,
California Department of Public Health, to Crystal Solorzano (Apr. 24, 2020)
re: Notice of Denial of Application, https://www.documentcloud.org/documents/20533881-change-of-ownership-denial-sequoias-post-acute-llc-04-24-2020-.
[14] Elly Yu and Aaron
Mendelson, “Immediate Jeopardy: Death And Neglect Inside A Troubled California
Nursing Home Chain,” LAist
(Apr. 6, 2021), https://laist.com/special-reports/nursing-homes-renew.php
[15] Jocelyn Wiener,
“California oversight of nursing homes called ‘befuddling,’ ‘broken,’” CalMatters (Apr. 16, 2021), https://calmatters.org/projects/california-oversight-nursing-homes/
[16] Id.
[17] Id.
[18] Id.
[19] Id.
[20] Id.
[21] Derek Brouwer,
“Investors With Questionable Records Want to Buy Five Vermont Nursing Homes.
Will the State Let Them?,” Seven
Days (Jul. 21, 2021), https://www.sevendaysvt.com/vermont/investors-with-questionable-records-want-to-buy-five-vermont-nursing-homes-will-the-state-let-them/Content?oid=33429007
[22] Id.
[23] Glenn Howatt,
“State regulators take control of Minneapolis nursing home,” Star Tribune (Oct. 25,
2021), https://www.startribune.com/state-regulators-take-control-of-minneapolis-nursing-home/600109876/
[24] Rebekah Allen,
“Inside Louisiana’s nursing home system that values profits over patients,” The Advocate (Apr. 29,
2017), https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_1940f13c-0f17-11e7-851c-97fd5a7b60fd.html
[25] Rebekah Allen,
“For Louisiana nursing homes, waves of campaign cash prompt favorable policy,” The Advocate (Apr. 30,
2017), https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_b399f0dc-14ce-11e7-be73-9307a966036f.html
[26] Rebekah Allen,
“For Louisiana nursing homes, waves of campaign cash prompt favorable policy,” The Advocate (Apr. 30,
2017), https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_b399f0dc-14ce-11e7-be73-9307a966036f.html.
[27] Rebekah Allen,
“How lawmakers, politicians voted to enrich Louisiana nursing homes, instead of
saving money,” The Advocate
(May 1, 2017), https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_1a746416-18af-11e7-bc81-efd9731624bb.html
[28] Editorial, “Our
Views: Nursing home policies should be scandal,” The Advocate (May 2, 2017), http://www.theadvocate.com/baton_rouge/opinion/our_views/article_991ffeb0-2dea-11e7-a907-b727dc1e8dac.html
[29] Ryan Mills,
“Neglected: Many of Florida’s best nursing homes lose under new funding plan,” Naples Daily News (May 15,
2019), https://www.naplesnews.com/story/news/local/florida/2019/05/15/florida-nursing-homes-best-lose-while-worst-gain-new-medicaid-plan/3105517002/
[30] Id.
[31] Id.
[32] Id.
[33] Ryan Mills and
Melanie Payne, “Neglected: Florida’s largest nursing home chain survives
despite legacy of poor patient care,” Naples
Daily News (May 31, 2018), https://www.naplesnews.com/story/news/special-reports/2018/05/31/neglected-fraud-and-abuse-nursing-homes-florida/542609002/
[34] Heather Stauffer,
“Lancaster nursing home formerly run by Skyline has a new operator,” The Courier Express (May 26,
2018), https://lancasteronline.com/news/local/lancaster-nursing-home-formerly-run-by-skyline-has-a-new/article_7df1ad0a-6057-11e8-937b-3393e543dbb7.html
[35] Daniel
Simmons-Ritchie, “Worst nursing homes continue to fail the frail despite
lawsuit and promises; Golden Living’s homes changed hands, but the care never
got better,” PennLive
(Nov. 26, 2018), https://www.witf.org/2018/11/26/worst-nursing-homes-continue-to-fail-the-frail-despite-lawsuit-and-promises/
[36] 42 U.S.C.
§1320c-5(b)(1)(B), (b)(2). See
Office of Inspector General, Exclusion Program, https://oig.hhs.gov/exclusions/
[37] 42 U.S.C.
§1320c-5(b)(3). See
Office of Inspector General, Corporate Integrity Agreements, https://oig.hhs.gov/compliance/corporate-integrity-agreements/;
Office of Inspector General, Quality of Care Corporate Integrity Agreements, https://oig.hhs.gov/compliance/corporate-integrity-agreements/quality-of-care.asp
[38] United States
Department of Justice, “SavaSeniorCare LLC Agrees to Pay $11.2 Million to
Resolve False Claims Act Allegations; Allegations Include Medically Unnecessary
Rehabilitation Therapy Services and Grossly Substandard Skilled Nursing
Services” (News Release, May 21, 2021), https://www.justice.gov/opa/pr/savaseniorcare-llc-agrees-pay-11.2-million-resolve-false-claims-act-allegations,
SavaCareCenter’s website identifies its 154 facilities in 18 states, https://savaseniorcare.com/find-a-center.html
[39] U.S. Attorney’s
Office, Western District of Tennessee, “Memphis Operator, LLC d/b/a Spring Gate
Rehabilitation and Healthcare Center will pay $500,000 to the United States and
the State of Tennessee for services to residents of Spring Gate that were
materially substandard and worthless” (News Release, Feb. 2, 2018), https://www.justice.gov/usao-wdtn/pr/memphis-operator-llc-dba-spring-gate-rehabilitation-and-healthcare-center-will-pay
https://www.justice.gov/opa/pr/savaseniorcare-llc-agrees-pay-11.2-million-resolve-false-claims-act-allegations
Download this report at: https://medicareadvocacy.org/wp-content/uploads/2021/12/Special-Report-SNF-Ownership-11-2021.pdf
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