In response to the shattering harms of the Covid-19 pandemic, Congress sought to shore up the U.S. health care system with billions of dollars in emergency aid. But the federal agency that helps to oversee the institutional care for the elderly, sick, and injured performed poorly as a steward of taxpayers’ hard-earned money.
The Health and Human Services department, instead, shoveled hundreds of millions of dollars, “no strings attached,” to dubious owners or operators of facilities nationwide. These “for-profit nursing home providers … have faced accusations of Medicare fraud and kickbacks, labor violations or widespread failures in patient care,” the Washington Post reported.
The newspaper said its analysis of HHS allocations of big sums in the Coronavirus Aid, Relief, and Economic Security Act, or Cares Act, also showed that:
“More than a dozen companies that received federal funding have settled civil lawsuits in recent years with the Justice Department, which alleged improper Medicare billing, forged documents, substandard care and other abuses. The companies repaid the government a total of more than $260 million and nearly all are under active corporate integrity agreements with the inspector general” of the same agency that doled out to them millions from the Cares Act. “The five-year agreements require independent audits, employee training and other enhanced reporting protocols.”
The newspaper’s dig into the sketchy awards includes these infuriating revelations and more:
- “One nursing home provider is still embroiled in active litigation with the government, which has accused the company in federal court in Tennessee of putting elderly residents into unnecessary therapy services and delaying the release of patients to reap higher Medicare payments. SavaSeniorCare, whose homes received more than $65 million in pandemic relief aid, has denied wrongdoing.”
- “Millions more went to nursing homes with widely publicized breakdowns during the pandemic. Among them: a facility in Pennsylvania cited by the state for giving more than 200 residents the experimental anti-malarial drug touted by President Trump and a home in New Jersey under investigation by the state attorney general for lapses in infection control and patient care during a lethal coronavirus outbreak earlier this spring. After an anonymous tip, police found the bodies of 17 residents in a makeshift morgue; another had been stored in a shed.”
- More than $35 million went to homes operated by the for-profit [company] Brius, with dozens of nursing homes in California, federal data shows. In 2016, officials at four Brius homes acknowledged in federal court that employees used corporate credit cards to buy massages, tickets to sporting events and excursions on the 222-foot mega yacht Inspiration Hornblower for hospital planners who provided patient referrals. The officials, who struck deferred prosecution agreements with the government, said at the time that Brius management was unaware of the scheme to maximize Medicare revenue. The four homes repaid $6.9 million through a settlement. Last year, the state threatened to fine one Brius home $156,000 after inspectors noted that a resident who had trouble swallowing choked on a honey bun and died, and another resident needed two surgeries after she fell out of her wheelchair while unattended. The home’s administration withheld records and instructed staff not to cooperate, according to the state inspection report.”
- “In New York, two homes that are part of the for-profit SentosaCare received more than $2 million in pandemic relief payments, federal records show. In October, a federal judge ruled that the owners of the company were liable for violations of human-trafficking laws after Filipino nurses brought to the United States to work in the two homes said they were overworked, improperly paid and threatened with $25,000 fines if they quit before their contracts ended. Elliot Hahn, a lawyer for SentosaCare, said nurses were not threatened and were paid an hourly rate of $29 or more. The company has appealed the ruling.“
- “The Life Care Center of Kirkland in Washington state, the site of the country’s first known coronavirus outbreak, received nearly $320,000 in pandemic relief. After the outbreak, CMS inspectors found the home did not properly care for sick residents or alert authorities to the spread of illness. The state banned the home, linked to more than 40 deaths, from accepting new residents until changes were made.”
Nursing home owners and operators contacted by the newspaper about their problematic pasts defended themselves. They said they were contesting earlier findings and that they needed the emergency aid to safeguard their residents during the pandemic’s unprecedented and demanding circumstances.
The newspaper, however, also reported that HHS, while racing to get emergency aid to long-term care facilities, failed to establish a common sense, fundamental requirement for the taxpayer dollars: The agency did not bar institutions from using the money to cover administrative or ordinary costs, especially to buttress revenues and return profits to shareholders of for-profit enterprises.
Though the agency was besieged by cries from the industry that institutions and health care workers in them were desperate for Covid-19 testing, personal protective gear, and help with other direct costs due to the pandemic (such as expenses for more staff time), HHS did not specify that its emergency aid was supposed to cover these burdens. As the newspaper noted:
“HHS opted for a simple distribution formula: Nursing homes would receive a $50,000 lump-sum payment, along with an additional allocation of $2,500 per bed. The average distribution was $315,000, with some larger facilities receiving $3 million or more, according to HHS. The money, HHS said in guidance to the industry, did ‘not need to be specific to providing care for possible or actual coronavirus patients.’ Providers could use the grants for a range of expenses, including health insurance, rent or mortgage payments, and equipment lease payments. Providers would have to comply with unspecified future audits and reporting requirements. ‘They should have specified that the money couldn’t just be used for administrative costs and profits,’ said Charlene Harrington, a nursing home researcher and professor at the University of California at San Francisco. ‘There was no reason that CMS couldn’t have put more restrictions on the money.’”
The Trump Administration fought with congressional Democrats about oversight for Cares Act emergency allocations, with the president asserting that he alone would somehow serve as watchdog for huge sums flooding from Washington, D.C.
A slim group of Democratic-led investigators has promised to pursue rigorous reporting on and auditing of where the emergency money from the Cares Act went and how long-term care facilities used those sums. The investigators also say they will dog the billions of dollars that HHS and the Centers for Medicare and Medicaid Services (CMS) in further aid promised to nursing homes and other long-term care facilities.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by abuse and neglect in nursing homes and other long-term care facilities. These institutions have become a nightmare during the Covid-19 pandemic, with 62,000 deaths of their residents and health workers — 41% of all coronavirus fatalities nationwide. “As of July 30,” the New York Times reported, “the virus has infected more than 362,000 people at some 16,000 facilities.”
Response to the disease’s savaging of some of the nation’s most vulnerable has been shocking and unacceptable — by regulators, political leaders, and lawmakers at the federal, state, and local levels. This was true at the outset for various reasons. It has become even more so, as politicians, including in the White House and the statehouse in Annapolis, bicker among themselves, and the coronavirus surges across the country, including in areas in which facilities had even more warning and time to prepare.
“Florida was one of the earliest states to lock down elder-care facilities in the coronavirus pandemic, and the move helped stave off widespread deaths at such centers in the spring. But as the state contends with a surge of new infections, those defenses have faltered … Daily fatality counts from elder-care facilities in Florida climbed to their highest level so far in the past week, with the seven-day average reaching 56 on Monday, about triple the average a month ago … Total long-term care deaths rose to 3,155 on Monday, representing about 42% of the state’s 7,526 fatalities overall, in line with the national trend … In June, the state began requiring facilities to test staff every two weeks. But public-health specialists say that unless the centers test staff, vendors, and others for the virus every time they arrive, there is no way to fully protect the elderly residents. Staff members may become infected at home but not show symptoms, and then come in close contact with residents.”
The newspaper goes on to note that facilities in Florida, like their counterparts across the country, are howling about the availability and cost of testing their staff and residents, as well as the expense of PPE, staffing, and other steep expenditures related to Covid-19. Industry officials estimate they will need $100 billion in federal help to withstand the economic hammering they are taking due to the pandemic.
It will be a leap, frankly, for taxpayers to ante up in that fashion — unless owners, operators, regulators, and a bevy of others first demonstrate that they can slash long-term care institutions’ Covid-19 deaths and infections. They, then, need to show they have used appropriately and even well the federal assistance they already have gotten. We’ve got a lot of work to do to safeguard the elderly, sick, and injured in institutional care and to get long-term facilities in a far better place