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Garden Valley Healthcare Center (CommuniCare) Investigation

Garden Valley Healthcare Center (CommuniCare) Investigation
Investigation into Poor Care and Possible Medicare Fraud at CommuniCare and Garden Valley Healthcare

The Medicare fraud and nursing home neglect lawyers at Mahany Law have combined forces to investigate claims of both poor patient care and billing fraud at the Garden Valley Healthcare Center in Kansas City, Missouri. We are looking to speak with would be whistleblowers (present or former employees) as well as patients or family members who have been injured or neglected at the facility

What We Know about Garden Valley Healthcare

Garden Valley Healthcare Center is a 156 for profit nursing home in Kansas City. It is owned and operated under by a CommuniCare affiliate.

Medicare gives the facility an overall rating of “Much Below Average.” Its health inspections have also been rated as much below average although the facility did manage an above average grade on some quality measures.

If the overall grade of much below average isn’t enough to scare you away, Medicare also says the home has been cited for abuse. Garden Valley has been cited 38 times. The average in Missouri and the United States is just 8.

We pulled the most recent full inspection report*. What we read is scary.

A random sample of personnel records showed that management had failed to verify the records of several staff members. Without proper background checks, its impossible to know if staff members have priors for abuse, neglect or criminal behavior. Given the facility’s track record of staff  members abusing patients, that is a big deal for us.

As we write this post, America still remains in the grips of the coronavirus pandemic. Many nursing homes have become the epicenter of the pandemic. In some facilities the death toll exceeds 100 residents. As we now know, coronavirus attacks the lungs. Without enough oxygen patients infected with COVID-19 die.

At CommuniCare’s Garden Valley home, inspectors found that staff were failing to properly clean oxygen concentrators used by patients. Given the compromised immune systems of most nursing home patients, it is critical that oxygen units and concentrator be kept clean. A random sample of devices used by several patients showed the filters in the machines were filthy.

That’s not the only violation. Inspectors found the facility had an unacceptably high medication error rate, some medications kept on hand had expired, one patient was observed bleeding through his pants (from a bedsore), the family of one patient wasn’t properly notified when their loved one was injured at the home… the list of violations goes on.

Perhaps most concerning was the failure of the facility to properly investigate and report an allegation of abuse. According to reports obtained from the Centers for Medicare and Medicaid Services, a resident reported to Garden Valley’s administrator on August 20th 2019 that he or she had been physically assaulted by a CNA. The facility’s internal investigation found that the report was unfounded. Under Missouri law, however, reports of physical abuse have to be properly reported and documented. Even if the complaint was unfounded, families can’t get peace of mind unless there is evidence of compliance with all assessment and notification requirements.

The August abuse allegation comes just 4 months after Medicare made an immediate jeopardy determination against the facility in April 2019. Investigators found a resident had been both neglected and abused. According to the government’s report:

“Based on observation, interview, and record review, the facility failed to protect one resident (Resident #1) from verbal abuse and neglect, when the resident fell out of bed and staff did not respond when the resident cried for help for eight minutes. Once observed on the floor, the staff failed to get the resident off the floor for over 10 minutes and verbally abused the resident while the resident begged for help.”

The nursing home’s records show that an LPN responded to the fall, got the patient back in bed and made all proper notifications. What neither the nurse nor the nursing home knew, however, was that the family had hidden a camera in their loved one’s room. But for the camera, the abuse of the resident probably would never have come to light.

The verbal abuse suffered by the patient was so bad that it can’t even be repeated in this blog. It’s important to remember that most nursing home residents are care dependent and must rely on staff for all their needs. They can’t simply walk out the door.

Ultimately Garden Valley suspended and later terminated the four employees involved in the incident.

Is Garden Valley Involved in Medicare Fraud?

Normally we investigate nursing homes for either fraud or patient neglect. Our investigation of Garden Valley Healthcare Center involves both!

While investigating a patient complaint we learned that the facility may be billing Medicare for medically unnecessary services. We have previously handled cases where nursing homes bill Medicare for services that were either not performed or that were not medically necessary.

Take for example physical therapy. If you are rehabbing after hip replacement surgery you probably need lots of therapy to get back on your feet and able to care for yourself. Physical therapy is totally justified. But what if you are 91 and suffering from late stage inoperable cancer? Why make a patient suffer from rigorous PT if they are not likely to ever walk again. In the latter instance, the nursing home should be keeping the resident comfortable.

Physical therapy must be ordered by a physician. We have a second hand report of unnecessary PT but we don’t know who has ordered it, if this is a widespread problem and / or if there is some type of kickback scheme going on.

Presently we are expanding our CommuniCare investigation to include Medicare fraud. Past or present employees have the inside knowledge we need to make a case. Under the federal False Claims Act, whistleblowers with inside information about Medicare or Medicaid fraud may be entitled to large cash rewards from the government.

Medicare fraud is not a victimless crime. It hurts taxpayers and if it involves medically unnecessary treatment, hurts patients too.

It’s not uncommon for nursing facilities engaged in billing fraud to also have poor grades for patient care. The owners of these homes are more interested in maximizing profits instead of better pay and training for staff and better care for residents.

Recently the Ohio Attorney General’s Office announced they had settled claims against CommuniCare, which owns many nursing facilities throughout Ohio. The company agreed to pay $1,500,255.41 although without an admission of guilt. 

The settlement resolves allegations that facilities owned by CommuniCare submitted and received payment for untimely claims.  Nursing facilities, like all Medicaid providers, have one year from the date of service to submit a claim for reimbursement to the Ohio Department of Medicaid (“ODM”).  If a Medicaid claim is submitted and denied by ODM, the Medicaid provider has up to an additional year to correct the submission error and resubmit the claim.

When Ohio launched a new Medicaid claims payment system, a software glitch failed to catch late filed claims. During this time frame, twenty-five CommuniCare nursing facilities in Ohio submitted claims for services that were more than two years from the date of service, which is outside the timely submission requirement.  Because the timely submission edit was turned off, these claims were paid. 

Lest you think this was an accident, Ohio says no other nursing facilities in the entire state submitted late claims during that time. All of the late filed claims had been previously submitted and denied. 

Seeking Garden Valley / CommuniCare Patients or Employees

We are currently investigating an allegation of poor patient care as well as information suggesting Medicare fraud. To better determine whether these complaints and allegations are true, we are seeking to speak with residents, their families and past or present employees. This is an investigation - we have not yet filed a nursing home neglect complaint and are not aware of any charges against Garden Valley except what has been reported by Medicare and discussed above.

Information for Patients

We are a law firm and multi-state network of nursing home abuse lawyers with an emphasis on elder law and the specialized needs of our older and disabled clients. If you have been asking the question, “How do I sue a nursing home?” call us at 833-201-155 or fill out the online review form to learn how our elder abuse lawyers can help you. We also recommend you visit our nursing home neglect information page.

Information for Employees

We are also one of the nation’s premier whistleblower law firms. Our wins include the largest whistleblower settlement in U.S. history ($16 billion) and a $92 million verdict.

We proudly represent coders, CNAs, physicians, nurses, clerks, housekeeping staff, pharmacists and other health care professionals working in or with long term care facilities who have evidence of resident abuse, neglect, assault or other cases involving federal or state programs such as Medicare and Medicaid.

Please help us solve the epidemic of long term care resident abuse and neglect. If you feel you have knowledge of elder neglect, abuse or assault and want to learn more about available cash whistleblower awards, contact us today for a fully confidential, no cost legal consultation. Even if you are not interested in a reward and just want to help patients receive proper care, we would love to speak with you.

We can be reached at 833-201-155 or with our online review form. All inquiries are protected by the attorney client privilege and kept strictly confidential. We also recommend you visit long term care whistleblower information page.

*Interested in information about other CommuniCare nursing homes? Medicare provides that information online and for free. There are so many nursing home review sites online but most of those sites are easily manipulated for better or worse with fake reviews. The best source is the Medicare Nursing Home Compare site.

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