Nursing homes accused of abuses get millions in aid
WASHINGTON — Forprofit nursing home providers that have faced accusations of Medicare fraud and kickbacks, labor violations and widespread failures in patient care received hundreds of millions of dollars in “no strings attached” coronavirus relief aid meant to cover shortfalls and expenses during the pandemic, a Washington Post analysis of federal spending found.
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 U.S. Department of Health and Human Services — the same agency that distributed the coronavirus relief payments. The five-year agreements require independent audits, employee training and other enhanced reporting protocols.
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.
All told, nursing home companies sued for Medicare fraud in recent years received more than $300 million in relief payments.
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 Donald 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 in the spring. After an anonymous tip, police found the bodies of 17 residents in a makeshift morgue; another had been stored in a shed.
The money was distributed through the $175 billion Provider Relief Fund, which since April has directed federal stimulus payments to hospitals, some nursing homes and other health care providers. In May, HHS announced a targeted nursing home distribution of another $4.9 billion.
The payments, for COVID-19 related expenses or lost revenue, came with few spending restrictions. Agreements between the providers and HHS include language prohibiting nursing homes from using the federal money for abortions, gun control lobbying and the purchase of chimpanzees, but they do not require homes to spend on such things as personal protective equipment or hazard pay for nurses and aides caring for COVID-19 patients.
“The president wants us to accelerate getting those dollars out,” Seema Verma, administrator for the Centers for Medicare and Medicaid Services, announced in April during a news briefing with the White House coronavirus task force. “There are no strings attached, so the health care providers that are receiving these dollars can essentially spend that in any way they see fit.”
Watchdog groups and some independent experts say the government should have assessed the financial needs of the nursing home industry, scrutinized the track records of providers and attached some spending restrictions before distributing the payments. They say they are most concerned about for-profit companies, some owned by private equity and other investment firms, that in the past have slashed costs and cut staff to boost profit.
Two publicly traded nursing home companies that regularly pay dividends to shareholders announced they continued to do so in the first two quarters of this year, the Post found.
Rep. James Clyburn, D-S.C., who chairs the House select subcommittee on the coronavirus crisis, launched a congressional investigation in June focused in part on grant spending by five nursing home chains.
“Our committee intends to conduct rigorous oversight to ensure that nursing home companies that received funds in order to deal with the crisis spend those funds as Congress intended,” he said in a statement to the Post. “Nursing home companies that received funds after committing fraud warrant particularly close scrutiny.”
HHS said providers will be required to undergo audits and submit spending documents, and those unable to show that money went to expenses or lost revenue attributed to the coronavirus could be forced to return some or all of the funds.
“HHS will have significant antifraud monitoring of the funds distributed, and the Office of Inspector General will provide oversight as required in the Cares Act to ensure that federal dollars are used appropriately,” according to HHS.
The American Health Care
Association and National Center for Assisted Living, which represents 14,000 long-term care providers, said the federal money was badly needed. The group has reported that both nonprofit and for-profit nursing homes had been “on the verge of collapse” during a deepening health crisis, faced with the increasing costs of supplies and personnel expenses and the loss of existing and potential residents.
The industry group said it expects reporting and tracking protocols.
“For several months, all health care providers have been waiting for guidance on reporting and HHS’ approach to auditing and are anticipating significant oversight in the coming months,” Mike Cheek, American Health Care Association senior vice president of reimbursement policy, said in a statement to the Post. “We support reasonable efforts to ensure this federal aid has been properly directed to providers to cover costs associated with addressing COVID-19 and potential losses.”
Whether that oversight prompts the government to flag irregular spending — or demand the return of stimulus money — is not yet known.