Priorities of For-Profit Nursing Home Industry Companies Overtakes Human Concerns

By Jeffrey J. Downey, attorney, serving Washington DC, Maryland, and the District of Columbia

Outsourcing.  Enrolling and Clearing.  These are terms that a for-profit company uses when discussing America’s elderly.  For such companies, nursing homes and assisted living facilities are not institutions for treating loved ones who need care but financial instruments used to continue the cash flow.

A recent article from The Capitol Forum (TCF), a Washington DC-based investigative news and legal analysis company, wrote about comments from several current and recent employees of Innov Age, the country’s largest provider of senior health care under a Medicare/Medicaid program.  In its reporting, TCF learned that Innov Age is enrolling patients into its program a rate that exceeds its ability to care for them.

This particular program in the health care industry which the private sector has become completely dependent on for profit is known as PACE, or Programs of All-Inclusive Care for the Elderly.  It is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.

Within the last year, Innov Age increased revenue by 8 percent, and it expects to open two new facilities in the next 18 months.  At the same time, the company said it has reduced debt by nearly a quarter of a billion dollars after an initial public offering in March of this year.  While at the same time, it continues to reduce staff.

It is a blank check for companies to enroll patients into their programs, some of which could be homeless. Innov Age employees told The Capitol Forum said that staffers were threatened as the company began to target homeless people, advertising at shelters, in order to meet a quota.

In some cases, there were inappropriate actions by companies requesting its staff to cancel appointments for diabetes or prescriptions of those who need care in order to meet compliance regulations from state and federal officials.

Separately, but just as troublesome, were the initial referrals for care from just specialists that were six months behind.  Innov Age’s procedure for handling such care concerns was to just cancel them altogether..

The Capitol Forum reported that emails sent from Innov Age leadership to its staffers to move the formerly homeless into nursing homes where they have a contract so that payments could continue from the federal government. Once individuals were enrolled, patients were to receive authorization by text or email to schedule their own appointments.  That was the extent of Innov Age’s outreach for seniors.  Text and email.  All done in the name to keep the money rolling into the company.

This is nothing new for the for-profit end of the health care industry explains healthcare fraud attorney Jeffrey J. Downey.  Most for profit companies will figure out a way to game the Medicare billing system, as we have previously seen with the provision of physical and occupational therapy.

In Michigan, for instance, it was reported that staffers for company named Medilodge, did not have the proper staffing to deal with residents that contacted the covid-19 virus.

The Washington Post labeled the process “gaming the system,” as referrals for physical and occupational therapy were the lures for new enrollees.  In the midst of the pandemic, respiratory care for Covid-19 patients in the new treatment showed the potential for gross overbilling.

If you or a loved one has knowledge of healthcare fraud or has been injured in a nursing home or assisted living facility, contact the Law Office of Jeffrey J. Downey, P.C.

Contact Information:

Law Office of Jeffrey J. Downey, PC
8270 Greensboro Drive, Suite 810
McLean, VA  22102
Phone: 703-564-7318
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