A consumer advocacy group is suing the state Health & Human Services Agency, alleging a systemic practice known as “patient dumping” – or illegally refusing to re-admit nursing home patients on the state subsidized healthcare program known as Medi-Cal after a hospital stay.
The lawsuit, Anderson et al v. Dooley et al, asserts as many as half of the nursing homes are illegally refusing to readmit patients after they are discharged for temporary care out of the facility. The goal of these facilities, allege plaintiffs, is to shed these patients in favor of either private pay patients or those who receive Medicare. For care of the latter, these facilities would pocket more money.
Federal law would require that a nursing home refusing readmission following temporary care allow for an appeal hearing. Further, states re required to enforce the decisions made at that hearing. These legal obligations were reportedly explained to the state health department explicitly back in 2012.
Public records indicate there have been a total of 500 appeals in the state over the course of the last decade, with out of 10 of those decided in favor of plaintiffs. However, plaintiffs said many who might be allowed to request a hearing don’t because they aren’t aware they have the right.
Although the state has denied doing anything illegal, two of the three named plaintiffs in the case are Medi-Cal patients who have been forced to stay in hospitals after the nursing homes where they previously resided refused to take them back. A third was finally accepted into another nursing home after months of applications.
The case is being filed with assistance from the California Advocates for Nursing Home Reform. The lawsuit alleges the nursing homes go through the motions of holding these hearings, but then the state refuses to enforce the findings in favor of the patients.
The complaint asserts these patients are not ill. They can walk and socialize and could be getting on with life, rather than existing in isolation in the hospital.
One of those who remains in the hospital has won his appeal, but was then told by the state it does not retain the jurisdiction to enforce the orders handed down by the Office of Administrative Hearings and Appeals.
Advocates with CANHR said they met with state health officials in October and were promised action on this issue. However, no action was taken.
The complaint asserts nursing homes face “strong financial motivation” to replace Medi-Cal patients with others covered by alternative modes of payment. While Medi-Cal offers a flat rat for all patients, they can make $500 or more in profit by taking in other patients.
Further, it isn’t just the nursing home residents who suffer, plaintiffs allege. Taxpayers too bear a large portion of this cost. Added up over the course of 10 years, the complaint alleges taxpayers have spent $70 million to keep these patients in hospitals when they didn’t need to be.
Our nursing home neglect lawyers know it’s not uncommon for patients in nursing homes to temporarily require care in a hospital facility. However, hospitals were never intended to be long-term care facilities. Putting profits over people in these situations is a clear example of nursing home negligence.
Call Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights. Now serving Orlando, West Palm Beach, Port St. Lucie and Fort Lauderdale.
Lawsuit claims California fails to correct nursing home misconduct, Nov. 11, 2015, By Stephanie O’Neill, 89.3 KPCC
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