One
of the major challenges today preventing the effective oversight of nursing
facilities is the dramatic change in ownership and management practices since
the Nursing Home Reform Law was enacted in 1987. Thirty-five years ago, most
facilities were individually owned (“Mom and Pops”) or were not-for-profit,
public facilities, owned by corporations, or owned by publicly traded
multi-state chains. Today, ownership and management of nursing facilities are
frequently shared by multiple individuals and entities – multiple limited
liability companies, real estate investment trusts, private equity firms, and
other private investors that often deliberately hide their connections to
facilities.
The
federal government has not promulgated new regulations to address the changing
ownership/management structures of nursing homes, leaving facilities and their
residents vulnerable to unscrupulous owners and operators. However, the federal
government has both the authority and the responsibility to assure that public
reimbursement is actually spent on resident care. The Nursing Home Reform Law
(1987) explicitly identifies as the broad “duty and responsibility of the
Secretary”
to
assure that requirements which govern the provision of care in skilled nursing
facilities under this subchapter, and the enforcement of such requirements, are
adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient
use of public moneys. [emphasis added]
More
can and should be done at the federal level. However, there is new evidence
that, even under existing authority, states may be able to address some of the
worst of the owners’ excesses.
In
the last few weeks, the New York State Attorney General, through the Medicaid
Fraud Control Unit, filed cases against three nursing facilities, alleging that
the facilities diverted millions of dollars in Medicare and Medicaid
reimbursement to excessive profits for the multiple owners, understaffed the
facilities, and provided grossly inadequate care to residents, before and
during the COVID-19 pandemic. If successful, these cases would address
ownership of the three facilities and could potentially lead to the
introduction of better and more comprehensive statutory authority to prevent
the abuses alleged in the lawsuits.
- For details on the three cases, and other
information, see https://medicareadvocacy.org/nursing-homes-addressing-the-worst-operator-behaviors-under-existing-law/
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