Articles Posted in nursing home neglect

Florida Gov. Rick Scott has required state agencies to hammer out ways to achieve significant cost savings over the next year.

Being floated around is roughly $430 million to Medicaid rate cuts. A proposal by the Agency for Health Care Administration would place 60 percent of that amount – some $274 million – on the shoulders of Florida nursing homes.

Our Broward nursing home neglect lawyers are concerned that such measures could result in an uptick in abuse, neglect and negligence cases at these facilities – many of which already are plagued by understaffing and lack of resources.

One nursing home director in north Florida was quoted by the Jacksonville paper saying two-thirds of his operational costs are salaries. If such significant cuts were made, something will have to give, and it will likely be salaries — hours or staff.

Here’s why that is so bothersome:

A study by researchers at the University of Pittsburgh’s Graduate School of Public Health and published in the American Journal of Infection Control, found that infections, which cause approximately 40,000 nursing home deaths in the U.S. each year, are largely the result of understaffing.

The study looked at data from some 16,000 nursing homes from 2000 to 2007 in a sample that was representative of 96 percent of all nursing homes.

Of those that had markedly low staffing levels, infection control deficiency citations were commonplace.

Why is this?

When a facility is understaffed, you have fewer people to do the same amount of work. So what happens is that quality control measures get missed. Caregivers skip things like thoroughly washing their hands or properly cleaning a resident after the restroom or turning a bedridden patient as often as necessary.

Numerous lawsuits in other states directly attributed the neglect or negligence experienced by patients to the lack of adequate staffing at the facility.

In late 2010, a jury in California awarded a $671 million verdict against a nursing home chain that allegedly provided too few staffers to meet patients’ needs – in direct violation of state staffing standards. The reason the award was so high was because the jury imposed the maximum for that violation – $500 per day per patient. The facility ultimately agreed with plaintiff attorneys to settle for $50 million so it could avoid bankruptcy. Similar lawsuits have been cropping up throughout the country ever since.

Florida first implemented minimum nursing home staff levels back in 2001, but they’ve since been reduced. Initially, nursing home residents were entitled to receive 3.9 hours of direct care every single day. Following approximately $187 million in Medicaid cuts last year, the state allowed facilities to reduce that figure to 3.6 hours. Of those, 2.5 hours have to be with a certified nurse.

It’s possible that these additional cuts, if implemented, could prompt state leaders to allow nursing home staffing levels to become even more lax, which could spell bad news for some of the state’s most vulnerable, elderly residents.
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We recently reported that a lack of nurses has led to increased levels of burnout and more infections throughout nursing homes in Florida.

Now, our Sebastian nursing home abuse attorneys understand that doctors, too, are experiencing those same kinds of work-fatigue that can lead to problems for patients – especially those in nursing homes, who are totally dependent on others for their care and well-being.

The new report, released by the Medical Society of the State of New York, reports that almost half of all doctors in the country indicate experiencing at least one major sign of professional burnout.

The team received responses from more than 7,250 doctors across the country. Those physicians worked in a variety of settings, including emergency care, family doctors, neurologists and those who oversee long-term care patients.

Undoubtedly, this can have an impact on the quality of patient care.

Adequate physician oversights at nursing home facilities in Sebastian and throughout Florida and the country is already in question. Many nursing homes don’t have an onsite doctor to evaluate even serious medical conditions. It’s often left up to nurses (who are overworked as well) to make critical calls on diagnosis and treatment.

That could mean that by the time a nursing home patient gets to a doctor, they are sicker.

It’s no surprise, then, that doctors are reporting higher rates of emotional exhaustion, a lack of enthusiasm, and increases in depression, cynicism and even suicidal thoughts. In fact, about 46 percent said they’d had at least some level of burnout.

Compare this to the general public, which has reported about a 28 percent rate of burnout.

Researchers reported that we all have a stake in this because when doctors are burned out or dissatisfied in their positions, we are more likely to see poorer patient outcomes, all sorts of medical errors and patients who don’t walk away having had a good experience under the circumstances.

Many media reports have also indicated that there is an increasing doctor shortage across the board. Those doctors who are available are more likely to gravitate toward fields that pay more – cardiac care, oncology, surgery, pediatrics – as opposed to geriatric medicine and care of the elderly.

With fewer access to preventative care for nursing home residents, we are likely to see a spike in emergency room visits for these individuals.

It can be difficult to know whether any given nursing home is going to provide adequate care for your loved one in terms of access to a doctor. Some questions you can ask ahead of time include:

–Is there a doctor on site? If not, how often does he or she visit or under which special circumstances?

–What are the physician’s qualifications?

–How can I reach the physician if I have questions about my loved one’s care?

–What is the ratio of staff to residents during each shift?

–How often with the physician review or change my loved one’s individual care plan? What is the protocol for handling any problems?
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Nursing home neglect in Fellsmere can take many forms – and it can be equally as fatal as outright abuse.

Florida nursing home neglect attorneys know that one of the most dangerous aspects overlooked by staffers at these facilities is food.

In some cases, it’s failure to feed the patient the right type of food for their ability. In other cases, it’s not paying close enough attention to what the person may try to eat or put in his or her mouth.

In fact, four recent choking deaths at nursing homes throughout Connecticut have prompted calls for more prevention training for nursing home aides and staff. However, it appears that these patients in particular were already on doctor-ordered, soft-food diets, meaning those employees already had instructions not to feed the person hard foods, and yet they did so anyway. The result was four deaths.

The most recent one included a nursing aide who fed a resident chunks of ham and pieces of a hard cookie. Doesn’t sound terrible, but the dietitian overseeing the patient’s care had already indicated that he was only supposed to have ground meat and soft foods. He suffered dementia and needed help with eating. Neither of those things reportedly happened. He choked and died as a result. The assistant later admitted she never checked the diet slip before she served him the meal. In fact, she says she knew of his diet, but believed the ham was soft enough to eat.

It’s a distinction she wasn’t qualified to make. Nursing home doctors will examine each patient to determine whether they get a certain kind of diet. Among the options are typically: whole, chopped, soft, pureed, liquid and in some extreme cases, a feeding tube.

The facility got less than a slap on the wrist – a $615 fine (out of a maximum $3,000) and an order to retrain staff on dining room protocol.

That’s it.

This incident followed another death in April in which a patient who was on a soft-food diet choked to death on meatballs that he’d had delivered to his room from a nearby restaurant. He wasn’t allowed to be ordering out, but he had a history of mental disabilities and staff knew he had previously ordered take-out.

A month earlier, an 82-year-old woman choked to death on a marshmallow, and a month before that, an elderly man choked to death while eating a peanut butter sandwich while unattended.

Then in Kentucky, a 2010 death is under state review, following new evidence that a nurse left a resident choking to death for 15 to 20 minutes before returning to find him deceased. That facility has been placed on the state’s “troubled facilities” list, though it’s not clear whether the nurse personally faced any sanctions.

The fact is, many nursing home patients have difficulty swallowing for one reason or another. Sometimes, it’s the result of a stroke or muscle weakness due to Alzheimer’s Disease or other ailments. The nursing home facility has a responsibility to care for patients in this regard, and to be vigilant in preventing choking and choking deaths.

This also involves the proper training of staff in acting swiftly once they realize that someone is choking.
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Martin County nursing home neglect attorneys read with great interest a recently-released report out of California, detailing allegations of widespread neglect and fraud at institutions throughout the state.

Given that Florida has the highest rate of senior citizens in the country (17.3 percent), these types of issues are of grave concern here. It behooves us to pay attention to what other state agencies are doing to address some of these same issues.

The California report was quite horrifying: there were inspectors’ reports of patients who were discovered with improperly-treated bed sores, patients who had been improperly medicated or over-medicated and those who had been left for hours in urine or feces without being cleaned.

Across the board, even in the so-called “good” nursing homes, there were systematic problems that included poor end-of-life care, avoidable dehydration, inaccurate diagnoses and not having an adequate level of fall protection.

The end result, of course, is that patients were being harmed. The degrees of harm were varied, but the aspect that tied them all together was the fact that these instances were unquestionably preventable.

The report stems from an investigation, dubbed Operation Guardians, launched by the state’s attorney general back in the beginning of 2010. That investigation dragged on through March of 2012, and paperwork is still being reviewed to determine what official action may be taken. Those findings have additionally been forwarded to the state’s health department, though formal action has yet to be taken.

The reports were publicly released by the state’s Advocates for Nursing Home Reform. That organization requested the documents through the attorney general’s office, and then subsequently released them to the media.

To break down some of what was found:

1. Inspectors at a facility in Bakersfield noted a resident’s diaper was in need of changing – and remained so for hours. Inspectors noted that the amount of water one resident was given in a feeding tube had been cut in half, causing the patient to suffer severe hydration. Doctors’ notations in patient charts were either illegible or lacking any meaningful, medical evaluation or both.

2. Inspectors at another facility in Pasadena noted that there was not enough wound prevention or treatment, a number of the patients were dehydrated and psychotropic medications were essentially being handed out like candy. Perhaps most horrifyingly, one patient had developed maggots in an open wound in his rectum, which was attributed to the staff’s failure to regularly and properly clean the wound.

3. In a facility in Sacramento, inspectors noted that one patient had half a dozen pressure sores, which had become infected due to staff’s failure to properly treat them. Staffers said the patient’s boyfriend had been directing staff to leave her alone, even though he didn’t have any legal authority to make those demands. She was transported to the hospital, where she died the following day. At this same facility, one resident was sexually assaulted by another. No physical exam was conducted, and the victim was not transported to the hospital.

Our Florida nursing home neglect attorneys understand that the non-profit has expressed frustration with another phenomenon that is frequently cited in Florida nursing home abuse cases: a lack of accountability. Despite the abuses and instances of neglect and fraud found by investigators, nothing has happened. It’s maddening. It makes one wonder whether these officials’ reactions would be the same if it were their own parents in these facilities.
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Troubling new research indicates a domino-effect of substandard care:

That there are fewer nursing teachers, which means there are fewer new graduating nurses, which means the nurses who are employed are quickly burned out which ultimately means more patients are suffering from higher rates of infection and neglect.

West Palm Beach elder neglect lawyers know that nursing is a necessary and demanding field that is often undervalued in our society. That said, nurses and employers remain responsible for their patients’ level of care. When that falls below a certain standard, it can mean life or death.

In fact, a new study from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing indicates that for every one patient that was added to a nurse’s workload, there was one additional hospital-acquired infection logged per 1,000 patients. That works out to about a 17 percent increase.

If a nurse was forced to take on 10 percent more patients, the study determined that it would result in two more surgical site infections and one more catheter-associated infections per 1,000 patients.

The research was the result of surveying more than 7,000 nurses and analyzing data from more than 160 hospitals.

It’s no secret that nurses have been reporting burnout for a long time. But when a study indicates that more than a third of nurses report “high levels” of burnout, you should find it alarming.

Although, perhaps it is not surprising, given another recent study indicating that the nursing shortage reported in recent years isn’t likely to dissipate anytime soon.

To take a closer look:

The U.S. Department of Health and Human Services says we already have about a quarter million fewer nurses in this country than what we need. By 2025, that shortage is expected to double.

The Joint Commission, which is a national agency responsible for accrediting hospitals, says that we can already attribute an estimated 100,000 preventable hospital deaths EACH YEAR to a shortage in nurses. If the shortage continues as expected, we’ll be seeing far more of these preventable deaths – particularly in nursing homes, which are generally not a nurse’s first choice of employment options.

Right now, there are about 20 states that have mandated nurse-to-patient ratios. Florida lawmakers toyed with similar legislation here back in 2010, but it ultimately failed. Some hospitals have their own policies, but they aren’t legally bound by those.

Although some may assume that not many people want to go into nursing – after all, as we said, it is quite demanding and, again, undervalued. However, the issue has more to do with a lack of qualified people to teach them.

We know that nursing school enrollment shot up in 2007 for the 7th year in a row. However, nearly 31,000 of those had to be turned away because there was no one to teach them.

A recent survey by the Association of Academic Health Centers indicated that more than 80 percent of medical, nursing and dental schools said there was a problem with finding qualified instructors, and almost half said it was a “severe” problem.

In order to teach nursing at the college level, you usually have to be a medical doctor or have some other similar advanced degree. But those working at a university usually make about $30,000 less than those working at a hospital.

Making a case for them to teach rather than stay can be tough.

What that means is we should unfortunately expect more instances of nursing home abuse in Palm Beach COunty and elsewhere.
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Nursing home neglect in Davie and everywhere else is often predicated on the fact that few people follow up to see what’s really going on.

In fact, countless acts of abuse and neglect have been perpetuated by staff who rightly assumed that those suffering can’t or won’t report what’s going on. Family members often live too far away to check on them and government oversight is often far too lax.

In a recent case in California, state investigators, acting on tips, made a surprise visit to a nursing home in Vallejo and uncovered some disturbing practices.

The report has only just now been making headlines after a non-profit combed through more than a dozen surprise inspection reports and posted them on their website. This particular inspection took place back in 2010.

They soon found one resident who was lying in a diaper that was soiled with feces. This might not be uncommon had the diaper been promptly change. However, not only was there old, dry stool inside the diaper, it took the staff at the facility more than an hour to change it after they had been notified by inspectors.

What’s even more troubling is that while an investigation into the nursing home continues, it still has a three-star rating by the federal government’s Nursing Home Compare website, which is a tool often used by family members to compare potential nursing homes for loved ones. This just shows how unreliable some of these sites are – and how important it is that once you do choose a nursing home facility, it’s critical to follow up.

Since that surprise inspection in Vallejo, that same facility has received a total of 66 complaints, and the Department of Justice has fined it nearly $56,000 for 18 violations of patients’ rights, safety, staffing and patient care.

The fact that a facility such as this is still in operation is more than upsetting – but it’s not uncommon, whether you’re in California or here in Florida.

Other recent surprise inspections include a March 2011 visit to a Vacaville facility, where investigators determined there were deficiencies in pain management, weight loss, staffing, infection control and the improper use of physical restraints.

However, even once the attorney general has won a civil injunction against a facility for these type of violations, it still is only granted the power to monitor the violator for a period of up to five years.

The problem with that there, as well as here, is budget cuts both locally and at the state level have limited how thorough those follow-up and monitoring efforts can be.

What that means is that it’s up to family members. One of the best ways to do this is to stop by unannounced or at different times. When staffers know to expect you, they will often try to ensure that appearances are kept up for when you are there. Arriving at differing times and on varying days throws them off and may allow you a more realistic look at what’s happening when you aren’t there.

Some warning signs to be on the lookout for include:

1. Unexplained injuries that may include bruising, scars or welts;
2. Evidence of being restrained, such as ligature marks on the wrists;
3. Reports of a drug overdose;
4. Unusual or unexplained weight loss, dehydration or malnutrition;
5. Untreated bed sores;
6. Unsanitary living conditions, such as soiled bedding, dirt, bugs, or a loved one who is left unbathed.
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One form of Palm Beach Gardens nursing home abuse that can often go unnoticed is that of prescription drug theft from patients.

It’s often not recognized as abuse or neglect in the sense we typically think of: bed sores, wandering patients, violence and the like.

We know that not only can such an act have serious or even deadly consequences to the patient if he or she is not receiving the proper medication, but it can also be an indication of greater problems with the level of care at any given facility.

Legislators in Florida could take a cue from their northern counterparts in Ohio, which has enacted a plan that is aimed at slashing the theft of prescription drugs from patients in assisted living facilities and nursing homes.

The attorney general of Ohio has issued a formal letter to nursing home officials throughout the state, imploring them to report to state officials when workers heist patient drugs.

Attorney General Mike DeWine was quoted by a Cleveland newspaper as saying that he believes this is a growing issue, though the statistics to back it up are scant. That goes back to the issue of reporting. If nursing homes have no incentive to report such abuses, why would they?

Like Florida, Ohio has a Medicaid Fraud Control Unit, which among other responsibilities is charged with overseeing theft of prescription drugs from disabled or elderly assisted living residents. There haven’t been a scourge of investigations by either state into this issue, but that’s not necessarily indicative of a lack of a problem.

In fact, we’re with DeWine in our inference of a ballooning problem in this regard, due to a crackdown in both states on pill mills, or facilities that basically operate with a front of legitimacy, but in reality only exist to cater to prescription pill addicts and dealers – mostly those in search of pain killers, such as oxycodone.

Reuters reported earlier this year that Florida officials had “declared success” in the battle against these operations, where doctors in 2011 were purported to have prescribed 10 times more painkillers than those in all the rest of the states combined. State Attorney Pam Bondi was quoted in February as saying that since then, there have been more than 2,100 arrests – including 35 doctors – resulting in a 40 percent increase in the prosecutions of prescription drug-related crime.

Of course, this is good news. But anyone who has ever met an addict knows they will go to any length to get their hands on their drugs – and they’re not above stealing it from the elderly and disabled. Less availability on the streets means an increased likelihood of theft in nursing homes.

The case that prompted DeWine’s letter was that of a 71-year-old resident who complained to state officials – over the protestations of nursing home administrators – that a staffer was stealing pain patches off his body.

As the attorney general rightly noted, theft of patient drugs deprives that person of needed medication – and is ultimately a form of abuse.
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The in-depth, enterprise reporting of the Miami Herald staff on the immense problem of nursing home neglect in West Palm Beach and throughout the state has earned the newspaper top honors.

Our West Palm Beach nursing home neglect lawyers applaud the newspaper for working to bring to light this widespread issue, which is sadly under-reported and often unnoticed.

Efforts like this four-part series, Neglected to Death, by the Herald’s I-Team, help to shed light on what is far too often swept under the rug.

The series focused on the deadly consequences of neglect at assisted living facilities and nursing homes in Florida, including poor supervision of Alzheimer’s patients leading to disappearances and death, inadequate and missing records and reports and unchecked violence inflicted by both other patients and staffers.

For these efforts, the Florida Society of News Editors awarded the three I-Team reporters the Gold Medal for Public Service in Division A, which is for newspapers with a circulation of 125,000 or more. According to FSNE, this is awarded for “meritorious public service by a newspaper through distinguished reporting, presentation and writing.”

The reporters exposed some abuses that had never before been revealed to the public. Some of those included one facility in Washington County, in the Panhandle. The scenes mirror something out of a horror movie: According to the paper, the nursing home director reportedly punished helpless residents by denying them medication and food, threatened them with sticks and doped them up with powerful tranquilizers.

When they broke the stiff rules, he beat them – in at least one case, sending a patient to the hospital.

But this was no movie – it was real life, and what is perhaps most maddening about it all is that the abuses had been reported to state authorities by multiple anonymous callers. When state regulators followed up back in 2004, he physically chased them off the property. And yet, he was allowed to remain open. Indeed, all that happened was that he was ordered to undergo anger management therapy and instructed not to use any object or weapon on his charges. He was allowed to stay open until 2009. By that time, the report indicates, he had broken just about every provision of the state’s assisted-living law. Among those abuses:

Throwing a woman to the ground and forcing her to sleep on a soiled box spring for nearly a week;

Forced residents to suffer without air conditioning, though temperatures spiked well into the 100s;

Fell asleep during an overnight shift, during which time a 71-year-old woman wandered from her bed, out the door and into a pond, where she drowned.

It was a telling scenario, because as the reporters put it: “The case represents everything that has gone wrong with homes once considered the pride of Florida.”

The truth is, it’s only the tip of the iceberg in this avalanche of reported abuses and neglect across the state.

While this type of reporting is critical to our understanding of the problems that exist in this realm, we are a long way from a permanent solution.

If you suspect a loved one has been neglected or abused in a nursing home or assisted living facility, you need to consult with an attorney as soon as possible. You owe it to each and every resident of that home.
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It’s true that residents in Vero Beach nursing homes may be more susceptible to infections than the general population.

Vero Beach abuse lawyers understand that is due in part to the fact that older people in general may be more at risk for infection.

However, the fact of the matter is some nursing homes are downright negligent when it comes to exposing patients in their care to serious – and preventable – infections.

It’s no coincidence that under-staffing directly leads to higher rates of infection.

Some examples of infections that stem from neglect would include Norovirus, sepsis, urinary tract infections (also known as UTIs), Hepatitis B or infections caused by improper treatment of wounds.

In a lot of instances, infections can be halted using a strict standard of cleanliness and care. Dangerous pathogens can be transmitted from a number of sources, including a caregiver’s hands, clothing, skin or medical equipment.

A study conducted by Johns Hopkins Hospital in 2005 indicated that in looking at over 100 facilities in Michigan, caregivers were able to all but eliminate certain types of infections by implementing procedures that included regular washing of hands, opening communication lines among caregivers, and ensuring that gloves and gowns are worn when necessary.

When these things don’t happen, the consequences can be tragic.

Consider the following real-life scenarios:

1. An outbreak of Hepatitis B at a North Carolina nursing home claimed the lives of four elderly residents there and sickened many others. Dirty needles were blamed.

2. Failure to properly treat the surgical wounds of a nursing home resident in Illinois resulted in her death in 2010. The woman reportedly had hip replacement surgery, but was not properly cared for once she entered the nursing home. Her family received a settlement of $2 million.

3. Norovirus, an illness that results in nausea, diarrhea and vomiting (severe cases can be deadly) broke out at a Chicago facility, where 129 residents were sickened. Failure to wash hands before food preparation is the most common cause of this viral infection.

4. Outbreaks of scabies in both Maine and Pennsylvania were attributed to unsanitary clothing and linens.

5. In New Mexico, a nursing home patient died after an infection that occurred after a bed pan, which had been forgotten by staffers, became embedded in his skin and caused a severe infection.

6. An Illinois woman passed away after nursing home staff failed to implement timely treatment for her UTI. As a result, she suffered from sepsis, dehydration, kidney failure and malnutrition, which ultimately led to her death.

Another very common bacteria found in nursing homes is Methicillin-resistant Staphylococcus aureus – better known as MRSA. It’s a very hearty, resistant strain of bacteria that can be passed due to uncleanliness. Those with open wounds or who have compromised immune systems are especially vulnerable. Signs of it include infections and open wounds, respiratory infections and UTIs. If it goes untreated, it can cause death.
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Our Tamarac nursing home abuse attorneys were appalled to hear of the squalid conditions of a Georgia nursing home: little food, skimpy air conditioning, plastic buckets catching the drips of leaky roofs, trash heaps and flies and rodents running rampant.

Sadly, Florida nursing home abuse attorneys know that this is not an isolated incident. This time, it was discovered by the Federal Bureau of Investigation in Georgia, where agents said elderly residents in three nursing homes there lived for years in horrid conditions. Meanwhile, the owner of the centers lined his pockets with fat Medicaid and Medicare checks, rather than investing that money to create a minimally acceptable environment for these residents.

According to a press release issued by the FBI, the owner of the three homes had pocketed some $33 million in government money – checks that were supposed to go to keeping up these properties.

You figure, this is an extreme case. How many long-term care residences and nursing homes skirt the minimum standards, simply so they aren’t caught?

The owner of these Georgia facilities was found guilty in Atlanta of defrauding Medicare and Medicaid. Additionally, his wife and accomplice pleaded guilty late last year.

As part of the agreement the pair had with the government, they promised to give residents in their care with a clean and safe environment to live. They also promised to feed them nutritious meals. They promised adequate medical care. They also promised access to certain social services.

But when family members, residents and even staffers started to complain that very little of that was being done, the owner simply didn’t respond to their concerns.

Some of those complaints were then forwarded to the FBI. Agents there kick-started an investigation, with the help of numerous federal and state agencies, including the Department of Health and Human Services, the IRS and the Office of Inspector General.

Investigators, who presented evidence at trial, were able to illustrate that the services provided by this nursing home owner were “worthless.”

In fact, the federal government determined that the nursing home owner didn’t hire enough staff. The staff he did hire started getting used to paychecks that bounced and health insurance premiums that lapsed, sticking many with large, unpaid medical bills and causing many of them to quit.

He also didn’t pay vendors. Those included the companies that were to supply food, medicine, laboratory services, trash disposal, medical waste disposal and basic nursing supplies.

Sometimes, employees would use their own money to buy basic food staples like bread and milk, so that the residents wouldn’t starve. They also frequently took the residents’ clothes home so they could launder their linens.

Meanwhile, the owner and his wife were buying hotel real estate, purchasing luxury cars, brand new furniture and paying for high-end child care.

FBI agents say the case is precedent-setting because it was the first time a person had been convicted in a federal trial for submitting claims for payment for services that were worthless.

When a nursing home collects taxpayer money for services that they don’t actually give or that fall short of what they should, not only is that fraud, it’s exploitative. The FBI notes some ways to identify fraudulent billing by a nursing home:

1. Residents appear to be living in unsafe or unsanitary environments.
2. Residents appear to be either dehydrated or malnourished.
3. Nursing homes send in “ghost-billing,” which are bills for patients who either don’t exist or who have already died..
4. The nursing home may offer free services or items to its residents, in exchange for a Medicaid or Medicare number.
5. The nursing home will “upcode” or put residents in a very high category of billing, which is typically reserved only for those who need care that is highly-specialized.
6. Giving patients medicine or using medical equipment that is inferior.
7. Billing the insurance company or the government for services that are never provided.
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