Tag: State News

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FWA (MS) – Mississippi man sentenced for $1.4 million in fraudulent medical charges

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Marion Lund stole $1.4M of your tax dollars. He did not say thank you.

 
 

Clipped from: https://www.picayuneitem.com/2023/05/mississippi-man-sentenced-for-1-4-million-in-fraudulent-medical-charges/

Published 4:07 pm Friday, May 19, 2023

By Special to the Item

 
 

A Panola County man was sentenced Monday to two years in prison following his conviction for his role in a scheme to defraud Medicare and TRICARE by prescribing and dispensing medically unnecessary foot bath medications and ordering medically unnecessary testing of toenails in exchange for kickbacks and bribes. According to court documents, Marion Shaun Lund, D.P.M., 54, of Batesville, owned and operated a podiatry clinic, as well as an in-house pharmacy in Oxford. Lund routinely wrote prescriptions for and dispensed antibiotic and antifungal drugs to be mixed into a tub of warm water for patients to soak their feet. Rather than prescribing drugs based on the individualized needs of patients, Lund prescribed foot bath medications in order to maximize reimbursements from Medicare, TRICARE and other health care benefit programs, regardless of medical necessity.

In addition, Lund took toenail clippings and wound cultures from patients and sent them to a lab for diagnostic testing, even though such testing was not medically necessary. From April 2020 through March 2022, Lund caused the submission of over $1.4 million in claims to Medicare and TRICARE for unnecessary prescriptions of foot bath medications and diagnostic testing of toenails, resulting in over $700,000 in reimbursements. In exchange for his prescriptions and orders, Lund was paid cash kickbacks by a purported marketer. On Feb. 2 Lund entered a plea of guilty to one count of conspiracy to commit health care fraud. On Monday morning, U.S. District Judge Glen Davidson sentenced Lund to 24 months in prison, followed by three years of supervised release and ordered Lund to pay restitution in the amount of $851,428.  Lund is the fourth defendant, including three medical professionals, to plead guilty and be sentenced for a role in the scheme. In October 2021, Logan Hunter Power pleaded guilty to one count of conspiracy to defraud the United States and to pay and receive kickbacks, and in October 2022, Power was sentenced to 25 months in prison. In August 2022, Jared Lee Spicer, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve a term of three years probation. In September 2022, Carey “Craig” Williams, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve 42 months in prison. Trial Attorney Sara E. Porter and Assistant Chief Justin M. Woodard of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Clayton A. Dabbs of the Northern District of Mississippi prosecuted the case.

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The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, composed of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes.

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EXPANSION (NH)- House Finance Subcommittee Wants to Hold Medicaid Expansion Bill for a Year

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: NH may not be re-upping its Medicaid expansion. Egads!

 
 

Clipped from: https://indepthnh.org/2023/05/23/house-finance-subcommittee-wants-to-hold-medicaid-expansion-bill-for-a-year/

 
 

The head of the state’s Medicaid program, Henry Lipman, talks to House Finance Committee’s Division III Tuesday about Senate Bill 263, which would reauthorize the Granite Advantage Health Care Program permanently.

By GARRY RAYNO, InDepthNH.org

CONCORD — A House Finance Committee’s subdivision wants to hold a bill reauthorizing the state’s Medicaid expansion program for a year.

Meeting Tuesday, the committee Division III voted down party lines to retain Senate Bill 263 although the Senate passed the bill unanimously and the House passed it 193-166 last week with no limitation on the program’s length.

The Granite Advantage Health Care program provides health insurance to the state’s “working poor” who earn too much to qualify for regular Medicaid, but not enough to purchase private insurance.

The program, which was part of the Affordable Care Act, provides Medicaid coverage to those from 133 to 100 percent of the federal poverty level with the federal government paying 90 percent of the cost.

The subcommittee voted down party lines, 5-4, to retain the bill, and the recommendation will go before the full House Finance Committee June 1 for its recommendation to the House for its June 8 session.

During last week’s session, Democrats and a handful of Republicans defeated about 20 of the 30 Republican proposed amendments to the bill, before passing it.

Many of the amendments defeated last week were brought up at the subcommittee meeting, including a work requirement, which the US Supreme Court had found unlawful in the past, as well as co-pays for services, drug testing, capping the length of time a person can be on the program and a clawback provision.

The list of concerns was developed by Rep. J.R. Hoell, R-Dunbarton, and read by Rep. Jim Kofalt, R-Wilton.

Rep. MaryJane Wallner, D-Concord, questioned why the subcommittee was bringing up the issues again.

“As I listen to the list it sounds sort of familiar to me. Many came forth last week as amendments and the House voted to reject them,” she said. “To bring them up at this point is not necessary and most of the things on the list are not related to finances.”

The bill received initial approval pending financial review by the House Finance Committee before a final vote on the bill.

But Rep. Erica Layon, R-Derry, who was a substitute member of the subcommittee, told Wallner debate was limited last Thursday when the bill was debated and many of the issues brought up were not debated on the floor.

“They were not thoroughly considered by limiting House debate,” she said.

Subdivision chair Rep. Jess Edwards, R-Auburn, said he talked with the bill’s prime sponsor, Senate President Jeb Bradley, R-Wolfeboro, who could not attend Tuesday’s meeting and said he told Bradley he was disappointed the House did not approve a six-year extension for the program.

Edwards said Bradley said a five-year contract with the Medicaid providers is best financially for the state, but contracts are often extended for a year or two.

Edwards said he could agree to a seven-year extension to accommodate that situation.

Henry Lipman, head of the Medicaid program for the Division of Health and Human Services, said the last contract had to be extended while the Executive Council sought additional information and input.

“Having that flexibility,” Lipman said, “makes sense.”
But Layon asked if it were more expensive to have the extension clause in the contract, but eventually Edwards said they probably would not know that until the final bids are known.

The chair of House Finance, Rep. Ken Weyler, R-Kingston, asked Lipman if there were no sunset provision in the bill, would it encourage the federal government to change how much it would pay for the cost..

Lipman said if the federal government drops its contribution to less than 90 percent, the current law requires the program to end regardless of what the legislators wanted to put in the current bill.

Kofalt said he believes a program as expensive and complex as the Medicaid program needs a sunset that would allow legislators to review it

He said there is often “creep” in programs as bills are introduced to add more benefits.

“This is a very, very expensive program to begin with,” Kofalt said. “(There needs to be) some kind of period to review the scope and complexity of the program. It really merits that.”
After a short caucus, Republicans moved to recommend the bill be retained with Layon saying work requirements are being debated  in Washington now in negotiations over raising the debt ceiling, and there may be other changes, so they would be wise to hold the bill for a year.

The bill has broad support among the business community, health care organizations and health care access advocates.

The subcommittee also voted down party lines to retain Senate Bill 239, which also passed the House last week.

The bill would have the state use harm reduction services to treat alcohol and other substance misuse and includes reauthorizing the needle exchange program.

But the subcommittee did recommend Senate Bill 172 pass, which allows court-appointed guardians to receive Temporary Assistance for Needy Families benefits for a child they are taking care of, such as grandparents or a mother’s sister.

The House has to act on these bills by June 8.

Garry Rayno may be reached at garry.rayno@yahoo.com.

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TECH – CSG Government Solutions Selected by the Department of Vermont Health Access to Provide IV&V for the Medicaid Enterprise System Modernization Project

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Let it ride another 8 years.

 
 

Clipped from: https://finance.yahoo.com/news/csg-government-solutions-selected-department-120000724.html

CSG Government Solutions, a national leader in government program modernization, today announced that it has been selected by the Department of Vermont Health Access to provide Independent Verification and Validation (IV&V) services for the design, development, and implementation of Vermont’s Medicaid Enterprise System Modernization Project, which includes the Medicaid Management Information System, Integrated Eligibility and Enrollment system, and Health Information Exchange.

CHICAGO, May 23, 2023 /PRNewswire-PRWeb/ — CSG Government Solutions, a national leader in government program modernization, today announced that it has been selected by the Department of Vermont Health Access to provide Independent Verification and Validation (IV&V) services for the design, development, and implementation of Vermont’s Medicaid Enterprise System Modernization Project, which includes the Medicaid Management Information System, Integrated Eligibility and Enrollment system, and Health Information Exchange.

CSG began its engagement with Vermont on this project in 2015. Under the new contract, CSG will continue to provide assessment and monitoring of Medicaid program operations, procurements, implementation activities, and adherence to the Centers for Medicare and Medicaid Services system certification requirements for federal funding.

“As Vermont’s Medicaid Enterprise IV&V partner, CSG has supported the federal certification for five system modules,” says Robin Dufresne, Director of CSG’s Healthcare and Human Services practice. “As we continue to leverage our expertise across the enterprise, we are well positioned to help assure the State achieves its goal of providing next generation health and human services capabilities.”

Media Contact

Robin Dufresne, CSG Government Solutions, 312.444.2760, rdufresne@csgdelivers.com

SOURCE CSG Government Solutions

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PROVIDERS (WA)- Washington Ambulance Companies Faring Better After Medicaid Boost

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: In which WA ambulance companies get $14M more a year, with some of it coming from higher mileage rates for the 50% of their rides that are really taxi rides. Uber anyone?

 
 

Clipped from: https://kpq.com/washington-ambulance-companies-feeling-better-after-medicaid-boost/

 
 

Ambulance companies across Washington State are feeling better after lawmakers increased their funding to carry non-emergency patients from point-to-point. 

The increase of nearly $14 million applies specifically to non-emergency Medicaid calls, which had not had a boost in funding for 19 years. 

Washington Ambulance Association President Mike Battis says Governor Inslee and the State Health Care Authority, which oversees the Medicaid program in Washington, supported the increase, but drumming up support in the legislature was more difficult. 

“I personally spent weeks over there this winter, living in hotels and meeting face to face with elected officials, kind of pleading our case,” said Battis. 

The increase in funding is seen as a major step in the right direction, but ambulance companies will still lose money on non-emergency Medicaid calls. 

“It’s the first step forward we’ve seen in two decades,” Battis said. “So, it’s refreshing and it’s encouraging that in the future, maybe, we can continue to use this as a steppingstone to get some more fiscal relief where it’s not losing money every time we go see a Medicaid patient.” 

Battis is also the Director of Operations for Ballard Ambulance in Wenatchee. He said about half their calls are for non-emergency transportation of patients, mostly through Medicaid or Medicare. 

Medicare reimburses at a better rate than Medicaid, which allows ambulance companies to more easily recover costs and break even on the calls. 

The Medicaid boost of $13.87 million from the legislature came through a line-item expenditure in the state operating budget. 

It amounts to a 64% increase for non-emergency advanced life support (ALS) ambulance service, which requires a paramedic on board, along with an Emergency Medical Technician.  

The boost is 80% for basic life support (BLS) transport, which is for patients with less severe conditions and requires two Emergency Medical Technicians.  

The increase is 35% to cover milage costs.  

Ambulance companies are only reimbursed for the miles a patient is transferred through Medicaid and Medicare. If a service such as Ballard is called to pick up and transport a patient from Colville to Spokane, Ballard is stuck with the costs of driving from Wenatchee to Colville, and from Spokane back to Wenatchee. 

Non-emergency calls take place when ambulances haul patients on scheduled trips, typically between two different hospitals or health care providers.  

The Medicaid non-emergency reimbursement rate has been so low that one of the largest ambulance companies in the world, Falck, recently pulled out of Washington state.  

The new rates go into effect on July 1. 

About 70-80 percent of calls handled by Washington ambulance agencies involve Medicaid or Medicare patients. 

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CMS NEWS- CMS-proposed HCBS rules elicit request for extension of comment period from 5 associations

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: We’d like a little more time to weigh in on the giant spotlight CMS wants to shine on HCBS quality issues, pretty please.

 
 

Clipped from: https://www.mcknightsseniorliving.com/home/news/cms-proposed-hcbs-rules-elicit-request-for-extension-of-comment-period-from-5-associations/

 
 

 
 

(Credit: kyoshino / Getty Images)

The executive directors of five national organizations are asking the Centers for Medicare & Medicaid Services to extend by at least 30 days the comment periods for two proposed rules related to access to care and managed care finance, access and quality in the Medicaid program and the Children’s Health Insurance Program. The current deadline is July 3.

CMS announced the two proposed rules April 27, as McKnight’s Senior Living previously reported. Among numerous home- and community-based services-related changes proposed in them, some quality measures for HCBS would become mandatory, states would be required to report every other year on the HCBS quality measure set for their HCBS programs, and the measure set would be updated “at least every other year” in consultation with states and other interested parties.

If finalized, CMS said, the proposed HCBS requirements would supersede and replace the reporting and performance expectations described in March 2014 guidance for Section 1915(c) waiver programs. Some assisted living communities provide HCBS such as personal care and supportive services to residents via those state Medicaid waivers.

CMS released its first-ever quality measure set for HCBS in July 2022, saying at the time that although the measures were voluntary, they were expected to become mandatory in the future. At the time, the agency “strongly” encouraged states to use the standards to assess and improve quality and outcomes in their HCBS programs.

The introduction of the measures, senior living industry advocates said then, came amid “longstanding, chronic underfunding” of HCBS that led to provider workforce shortages. The financial issue needed to be addressed, the groups said, noting, however, that they supported the quality improvement effort in general.

In a letter last week to CMS Administrator Chiquita Brooks-LaSure, the executive directors of ADvancing States, the National Association of Medicaid Directors, the National Association of State Head Injury Administrators, the National Association of State Mental Health Program Directors and the National Association of State Directors of Developmental Disabilities Services said they needed more time to review the CMS-recommended policies, which the groups described as “complex, far-ranging, and touch a diverse array of programmatic areas.” The organizations represent Medicaid directors and leaders of Medicaid home- and community-based services waiver operating agencies.

“As our members embark on an intensive period of work conducting long-paused Medicaid renewals, winding down the COVID-19 public health emergency and its attached flexibilities, and continued management of HCBS investments from the American Rescue Plan, agency bandwidth to thoughtfully respond to regulatory actions of this magnitude by the current July 3 closure of the comment period is extremely limited,” the executive directors said.

The review process for Medicaid renewals involves more than 90 million individuals currently covered by the program, the executive directors pointed out.

“The resources necessary to focus on this work directly impact the ability for our members to carefully review CMS’s proposals, understand their impact, and articulate the resources, systems needs, operational considerations, and other factors necessary to achieve success,” they wrote. “Without additional time for our members to conduct such assessments, CMS may not receive the level of policy and technical feedback that would best situate final regulatory action for successful implementation.”

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PHE/ RTNO (FL) 250,000 Florida residents kicked off Medicaid; more expected

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: 13.8% of the 1.8 ineligible members on the FL Medicaid rolls were removed this month as the state returns to normal operations.

 
 

Clipped from: https://www.tampabay.com/news/health/2023/05/17/florida-medicaid-eligibility-coverage-children/

 
 

Health advocate groups are calling on Florida to halt a review of the eligibility of Medicaid recipients after close to 250,000 residents were terminated from the program during the past four weeks.

The Florida Department of Children and Families began a purge of the more than 5 million people from the state’s Medicaid rolls on April 18 as part of the winding down of the public health emergency that took effect May 11. Since then, state workers have reviewed more than 461,000 people, taking Medicaid benefits away from more than half.

About 80% of those terminated — roughly 205,000 — were disqualified because they failed to respond to requests for information needed to renew their eligibility, the state report shows. About 44,300 recipients were referred to other programs because they earn too much to be eligible.

The high number of so-called procedural terminations has alarmed health advocacy groups, who fear families, including children who are still eligible, will lose coverage because they were unaware of the requirement.

The Florida Policy Institute, an Orlando nonprofit group, was among groups who earlier this year warned of a “looming tidal wave of health coverage loss for children, parents, and young adults.” CEO Sadaf Knight on Wednesday said the state should pause the process and re-enroll those who have been removed until it has checked their eligibility.

“We have consistently urged the state and administration to do everything in its power to ensure no eligible child or parent was kicked off of health coverage because of bureaucratic inadequacies,” he said. “Now, the first reports confirm our fears about unnecessary losses in coverage. There is no excuse for the loss of health coverage for over 200,000 Floridians due to procedural ‘red tape.'”

The state’s Medicaid rolls swelled by nearly 1.8 million people since 2020, when the federal government paid states extra money to keep people covered during the pandemic, even if they were no longer eligible. Similar checks on recipients are being conducted in every state across the nation in accordance with instructions from the federal government.

The Department of Children and Families earlier this year released a plan to send renewal notices to recipients through emails and letters.

The plan states those who lose coverage will be referred to alternatives, including Florida KidCare, a government-sponsored health insurance program, and federally subsidized health centers that treat low-income patients. Hillsborough County also runs a health care program for low-income residents funded through a sales tax.

Hillsborough County received 877 new applications for its program in April. As of Wednesday, more than 1,060 people had applied this month, said spokesperson Todd Pratt.

“The federal pause on Medicaid redeterminations for the last three years has been unprecedented,” said Department Secretary Shevaun Harris in an April 18 memo to health care groups. “This change reflects a return to normal operations.”

Florida is one of only 10 states that have not taken advantage of a provision in the Affordable Care Act that rewards states for expanding Medicaid to more low-income residents.

Florida’s Medicaid program covers children ages 5 and younger in households that make $33,408 or less and older children whose parents make up to $31,795. But there is no coverage for parents who earn more than $7,000 a year, and adults with no children are ineligible no matter how little they earn. Only four states in the nation have stricter Medicaid eligibility, according to the Florida Policy Institute.

The Florida Health Justice Project is also calling for a halt to the state’s Medicaid review
process. Eligible families with children who rely on Medicaid could fall through the cracks and be disqualified, said Alison Yager, the project’s executive director. She also questioned whether the state was following
its plan to prioritize reviewing people who no longer qualified and those who have not used Medicaid services.

“It raises all kinds of questions about whether people are getting their correspondence or are having trouble getting through to (the Department of Children and Families),” she said. “People still don’t know this is happening.”

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PHE/RTNO (AR) – Medicaid Redetermination, Sanders’ Healthcare $$$ Plans & AI for Mental Health

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Axios points out that getting Medicaid cards converted to exchange-plan cards (subsidized by tax dollars) could mean higher payments to providers.

 
 

Clipped from: https://www.managedhealthcareexecutive.com/view/medicaid-redetermination-sanders-healthcare-spending-plans-ai-for-mental-health-the-news-cycle

Medicaid redetermination may result in a favorable payer mix for some providers if people switch to ACA and employer-based coverage that has higher payer rates. But that is a pretty big if.

Medicaid redetermination could be good for providers, hospitals | Axios

The Kaiser Family Foundation has estimated that 17 million people could lose Medicaid coverage as result of Medicaid redetermination and the end of the automatic re-enrollment into the public payer programs that was part of the government’s response to the COVID-19 pandemic. If people losing Medicaid coverage don’t switch to other kinds of coverage, the consequences could be dire for their access to healthcare. A growth in the number of uninsured Americans could also put a strain on health systems and providers, Axios reports this morning (full text available). But the news brevity website also mentions an alternative scenario whereby substantial number of people losing Medicaid coverage switch to employment-based and ACA coverage, which pay providers at a higher rate than Medicaid programs. “Redeterminations could change the payer mix in a revenue-positive way if patients for from Medicaid to employer-sponsored or ACA plans,” writer Axios’ Arielle Dreher.

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PROVIDERS (NH)- Senate Finance votes to reduce Medicaid payment increase for providers by $15 million

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ask for $200M more, get $119M more.

 
 

 
 

PROVIDERS (NH)- Senate Finance votes to reduce Medicaid payment increase for providers by $15 million – New Hampshire Bulletin

 
 

Clipped from: https://newhampshirebulletin.com/briefs/senate-finance-votes-to-reduce-medicaid-payment-increase-for-providers-by-15-million/

 
 

Providers had requested an additional $200 million in the next budget. (Getty Images)

Mental health centers, midwives, home health care aids, and other human service providers may see a smaller increase in Medicaid payments than the $134 million the House approved. 

The Senate Finance Committee voted, 5-1, Tuesday to cut the House’s increase by $15 million, which would give providers about a $119 million increase. 

With the federal match for Medicaid, that is at least a $30 million decrease in Medicaid funding.

Providers had requested an additional $200 million in the next budget. The governor proposed $24 million. The House increased that to $134 million after providers said the state is paying them so little in Medicaid that they can’t hire staff or adequately care for the state’s most vulnerable residents.

Senate President Jeb Bradley, who authored the amendment reducing the House amount, called the $119 million a “huge appropriation of dollars.” 

“We’ve got several huge items: housing, child care, pay raise for state employees, education funding, and Medicaid provider rates,” Bradley said. “If we don’t, at least in my opinion, make a pretty concerted effort to enhance our Medicaid provider rates, our health care system and everybody that depends on it is going to suffer.”

Bradley’s amendment would also give the Department of Health and Human Services more flexibility than the House did in deciding how to target increases to various providers. 

Sen. Cindy Rosenwald, a Nashua Democrat on the Senate Finance Committee, was the lone no vote. She noted that the committee also cut other Medicaid funding by more than $100 million on Tuesday. 

“I’m really concerned about this,” she said. “We do have the revenues to do it in the next biennium, and I would hope we would have the will to continue with this important workforce piece.”

The Senate Finance Committee’s proposed budget will go before the full Senate next, and then to the House, which can agree or challenge Senate changes. 

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PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Details on poor quality in the RI nursing home market. In this article, explained entirely by payment gaps (that have been in place for 11 years).

 
 

PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

 
 

Clipped from: https://www.mcknights.com/news/medicaid-and-leadership-challenges-as-state-takes-over-nursing-home/

 
 

 
 

A Rhode Island nursing home with more than 30 citations for deficiencies and whose administrator’s license was suspended last month has been put into state receivership. 

While declining to comment about the situation at the facility itself, the sector’s leading advocates in the state told McKnight’s Long-Term Care News that the broader picture of nursing homes in distress has become acute due to surging labor costs and chronic underfunding. 

“Rhode Island Medicaid has been chronically underfunded for more than a decade,” said John Gage, president and CEO of the Rhode Island Health Care Association.

The state’s Medicaid rates are based on 2011 actual costs inflated by approximately 1% per year since 2012, Gage said. The estimated shortfall is $50 million to $60 million per year, and the pre-pandemic gap between reimbursement and the cost of care was approximately $30 per patient per day. Both Gage and his counterpart at LeadingAge Rhode Island, which represents nonprofit facilities, said the gap is likely much higher now.  

“We have a high rate of Medicare Advantage beneficiaries, and those plans don’t pay as well as 

traditional Medicare, so providers are squeezed on that end,” explained LeadingAge Rhode Island CEO James Nyberg. 

On top of that, the state’s skilled nursing facility workforce is down approximately 20% since the pandemic – registered nurses are down 16.5%, licensed practical nurses are down 18.3%, and certified nursing aides are down 25.4%, Gage said, adding that the usage of expensive staffing agency personnel has quadrupled.

What’s more, in 2021, the state approved a staffing minimum requiring 3.58 hours of direct care per patient per day that Gage said will cost approximately $60 million per year while funding was set at just $12 million per year. 

“Clearly, something has got to give,” he said. 

There are 80 nursing homes in Rhode Island, including the Charlesgate Nursing Center, which is in the process of closing due to staffing challenges and inadequate Medicaid reimbursements, Gage said.

Pattern of issues

The state Department of Health made a surprise inspection of the Pawtucket Falls Healthcare Center in October. What followed has been detailed in local media as a volatile situation in which a resident’s broken bone from a fall was not noticed for two days, staff medical errors, improperly administered COVID tests, and other problems. 

State investigators also said that former Administrator Sami Almadi “tried to deceive them” about discharge papers for a resident, who complained about an improper discharge. NBC10 reported that Almadi presented a discharge form on which at least one of two nurse’s signatures was forged. Almadi’s license was suspended last month, the station’s report said.

A court-appointed receiver has now been charged with overseeing the facility. A statement from the state’s interim health director said the department “tried to help the facility stabilize” but that a “pattern of health and safety issues” over the last seven months led to the receivership, NBC10 reported.