The U.S. Attorney's Office announced Monday that it filed a civil complaint alleging that an Erlanger nursing home provided "worthless" services that resulted in the deaths of five residents and injuries to others.
Villaspring Health Care and Rehabilitation, Villaspring's parent company, Carespring Health Care Management, and its owner billed Medicare and Medicaid for services purportedly provided to its residents, despite knowing that the services were so inadequate that they were essentially worthless, according to a statement from Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky.
This is the first suit filed in Kentucky in which the government alleges that a nursing home defrauded Medicare and Medicaid by submitting bills for reimbursement while providing systemically poor resident care.
The complaint accuses nursing home officials of violating the federal False Claims Act.
"Today's filing represents an important milestone in the effort to insure effective care for Medicare and Medicaid recipients in long-term care facilities," Harvey said in a statement. "In appropriate cases, the False Claims Act will be an important tool to protect both the taxpayers and federal health-care program beneficiaries."
The complaint alleges that from 2004 to 2008, numerous patients suffered serious injuries; five of those patients died. Some of the residents who died went days without baths; they weren't given enough to drink; and their pressure sores were not treated, leading to fatal infections, the complaint alleges.
On Monday, officials at the nursing home — also known as Villaspring of Erlanger — held a press conference to deny the allegations and emphasize that they currently comply with all state regulations. Carespring officials invited the media to tour the home.
"We do not feel that the government's case has any merit, and we will defend ourselves vigorously," said Kim Majick, a spokeswoman for Carespring. "The Federal Government is alleging we didn't provide services that we did in fact provide. Villaspring has consistently provided high-quality care to the residents of Kenton County and looks forward to doing so in the future."
The alleged inadequate care included failure to follow physicians' orders, failure to treat wounds and pressure sores, failure to update resident care plans, and failure to monitor the blood-sugar levels of diabetic residents.
In 2010, the Herald-Leader reported that a June 2007 state citation against Villaspring of Erlanger said that a resident developed sepsis when the home didn't monitor pressure ulcers. In December 2007, nursing home officials were cited by the state for failing to monitor a resident's dose of Coumadin, a drug that prevents blood clots.
After investigating the allegations about Villaspring of Erlanger, Kentucky Attorney General Jack Conway referred them to the U.S. Attorney's office, Conway spokeswoman Shelley Johnson said.
The complaint filed by the U.S. Attorney's Office provided details on several cases, including:
■ A man who entered the home in July 2004 was alert, able to use the toilet with assistance and had no limitations on his mobility. But the day after he was admitted, the staff put the man in adult diapers. They later restrained him against his physician's orders. The complaint also said that within a few weeks of being admitted, the resident had unexplained bruising and red marks, leading the assistant director of nursing to ask him if he was being threatened or "verbally mistreated."
There were numerous instances of the man not getting a bath for six to 10 days, and he became dehydrated after not receiving enough liquids. He was sent to the hospital emergency room and admitted with diagnoses of a serious urinary infection, dehydration and a large pressure ulcer. He underwent surgery to remove his coccyx bone and another bone from the site of his most severe pressure sore.
The resident was transferred to another rehabilitation hospital, where he refused food and medicine. He died in March 2005.
For their treatment of the resident, nursing home officials submitted claims to Kentucky Medicaid, which paid $21,249, the complaint said.
■ A woman was admitted to Villaspring in November 2004 after a fall and subsequent surgery for a broken hip.
When she was admitted, she was alert and had no history of incontinence. But nursing home staff put her in adult diapers. She developed bed sores that became so infected that her left leg had to be amputated above the knee. She died of a blood infection on March 31, 2005.
In that case, Medicare paid claims totaling $12,896, the complaint said.
"These allegations are over five years old; we cooperated fully with the state investigators, and made changes that put us into compliance," Majick, the Carespring spokeswoman, said Monday. "Since then, we have operated exceptionally; in total compliance with the state regulations."
A December 2010 inspection — the latest that was available on the state cabinet's Web site — found only minor problems in the dining room, including a dirty meat slicer and pans that were stored wet.
Cabinet for Health and Family Services spokeswoman Beth Fisher confirmed Monday that "there is no pending investigation of corrective action at the facility at this time."
If found liable in the federal civil complaint that was announced Monday, nursing home officials would face penalties of between $5,500 and $11,000 for each false claim. Nursing home officials also would have to repay Medicare and Medicaid three times the amount of the government's loss for the fraud.