PacifiCare Faces $1.3 Billion in Penalties for Over 130,000 Violations

California Insurance Commissioner Steven Poizner and the Director of the California Department of Managed Care (DMHC), Cindy Ehnes, announced that they are seeking $1.3 billion for over 130,000 alleged claim violations made by PacifiCare. It is the first action ever taken by both departments against a single health care provider.

Details of the violations

The Department of Insurance conducted market examinations that reviewed PacifiCare files between July 1, 2005 and May 31, 2007. It identified over 130,000 violations – each subject to penalties of $5,000 for non-willful violations and up to $10,000 for willful violations. When you add those numbers up, PacifiCare faces fines of between $650,000 to a staggering $1.3 billion (and this is not a typo – that’s billion, with a ‘B’.) The examinations were conducted in response to hundreds of complaints received from both consumers and providers.

The alleged violations include:

• Wrongful denials of covered claims
• Incorrect payment of claims
• Lost documents including certificates of creditable coverage and medical records
• Failure to timely acknowledge receipt of claims
• Multiple requests for documentation that was previously provided
• Failure to address all issues and respond timely to member appeals and provider disputes
• Failure to manage provider network contracts and resolve provider disputes

Other violations / recoveries

According to a joint press release, the DMHC has already assessed the company, which was acquired by United Healthcare in 2005, a $3.5 million penalty for its practices – the largest fine it has ever imposed. The Department of Insurance also directed a self-audit of the company for unfairly denying coverage for pre-existing conditions. That audit resulted in over $750,000 in claims recoveries.

Putting an end to unfair claims practices

According to Poizner, this joint effort is meant to put an end to unfair claims practices in California. In a press release, he said:

Paying claims is the heart of the insurance business model and the most fundamental job insurers must perform. After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims paying process. We’re going to put an end to that. If PacifiCare can’t understand the ABC’s of basic claims payment, maybe it will understand the dollars and cents of regulatory action.

To view the press release, go to: http://www.dmhc.ca.gov/library/reports/news/prpchbcp.pdf.

SOURCE:  attorneypages.com

Jury imposes maximum damages on Skilled Healthcare; nursing home chain faces upwards of $600 million for health code violations

Eureka Healthcare

The jury in the class-action lawsuit against Skilled Healthcare returned to Humboldt County Superior Court and rendered a verdict on Tuesday, opting to impose the maximum amount of damages totaling nearly $619 million for health code violations.

The verdict comes more than seven months after the start of the case, which is believed to be the longest civil suit in Humboldt County history.

”This is a really strong statement to Skilled Healthcare that they have to follow the law,” said plaintiff’s Attorney Michael Thamer, who delivered the closing arguments in the case and specializes in fighting corporate abuse. “They need to know that they are going to be held responsible.”

The issue at the heart of the case is a California statute that mandates 3.2 nursing hours per patient per day. The lawsuit covers the years 2003 to 2009, and represents a class of some 32,000 patients.

Along with the statutory damages, the jury awarded an additional $58 million for a violation of the California Consumer Legal Remedies Act, bringing the total damages to nearly $677 million.

Skilled Healthcare is one of the largest nursing home chains in the country, employing approximately 14,000 people. The company is based in Southern California, and operates 78 nursing facilities in seven states.

Eureka, Granada, Pacific, Seaview and St. Luke Healthcare and Rehabilitation are the five Skilled Healthcare facilities here in Humboldt County. The
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total amount of damages imposed on the five Humboldt County facilities is nearly $135 million.

Because of multiple changes to the computer system the courthouse uses to track cases, there is no way of determining how the length of the Skilled Healthcare lawsuit compares to previous Humboldt County civil suits. But many people in the courthouse say the trial, which began November 30 of 2009, is the longest civil suit in county history. And it isn’t over yet.

Next week the jury will decide the extent of additional punitive damages. Judge Bruce Watson will then decide if the court will issue an injunction against Skilled Healthcare that would mandate the company to keep staffing levels compliant with the law in the future.

Defense Attorney Kippy Wroten was not in court for the verdict and declined to comment, instead issuing a statement via e-mail.

”With respect to the court and to these judicial proceedings as a whole, we strongly disagree with the outcome of this legal matter. We remain confident that our facilities are well staffed and are extremely disappointed with this result. Unfortunately we cannot comment further as the matter is ongoing.”

The second phase of the jury trial, which will establish the net worth of the company in order for the jury in order to decide the extent of any punitive damages, is set to begin next week.

Cindy Cool testified earlier in the case on behalf of her father, a former patient at Eureka Healthcare and Rehabilitation before he died from complications of Alzheimer’s disease. Cool was in court again Tuesday, and had to fight back tears after she heard the verdict.

”I’m so thankful for this,” said Cool, who added that while it may be too late for her father to receive justice, she hopes the lawsuit makes things better for future patients. “We just want our loved ones to be taken care of.”

BY THE NUMBERS:

The following is a breakdown of the penalties imposed on Skilled Heathcare’s five Humboldt County facilities by the jury. These numbers include statutory damages and penalties for violating the Consumer Legal Remedies Act:

* Eureka Healthcare and Rehabilitation Center, LLC — $25,573,913

* Granada Healthcare and Rehabilitation Center, LLC — $30,880,270

* Pacific Healthcare and Rehabilitation Center, LLC — $13,620,239

* Seaview Healthcare and Rehabilitation Center, LLC — $26,732,565

* St. Luke Heathcare and Rehabilitation, LLC — $37,893,698

TOTAL — $134,700,685

SOURCE: mercurynews.com Matt Drange/The Times-Standard
Posted: 07/07/2010 01:30:15 AM PDT

Click here to read the article

CALIFORNIA STATE PLAN ON AGING 2009 - 2013
The California Department of Aging has prepared the California State Plan on
Aging – 2009-2013 to promote the independence and well-being of older
adults, adults with disabilities, and their families. These individuals may have
a variety of needs related to their physical, mental and emotional well-being.
At the same time, these individuals are resilient and have much to contribute
to their communities.
By 2020, persons age 60 and older will comprise nearly 20 percent of
California’s total population. Increasingly diverse groups of older adults and
adults with disabilities – adults who are determined to age in place and
fiercely guard their independence – will require us to examine how we deliver
services.

California’s population of persons 60 and older has grown rapidly throughout
this century. Between 1950 and 2000, the number of older adults in this State
grew from 1.6 million to 4.7 million, an increase of 194 percent. This trend will
continue as the number of people age 60 and over grows to 14.6 million by
2050, an increase of 128 percent from 2010. By 2050, it is estimated that
nearly 25 percent of Californians will be 60 or older.
While approximately 628,000 Californians are 85 or older today, by 2050 an
estimated 2.9 million individuals will be in this age group, a dramatic 364
percent increase. This rapid growth has many implications for individuals,
families, communities, and government.

SOURCE: www.aging.ca.gov

CLICK HERE TO READ THE PLAN ON AGING

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Podcast of the KVEC Radio Show The Best is Yet To Be
Kitty Wilde RN was interviewed by Deborah Bayles about quality aging in place.

Today Elder Care Residential Services CEO Kitty Wilde RN was interviewed by Deborah Bayles the Radio Host for ” The Best is Yet to Be” on KVEC Talk Radio 920 in San Luis Obispo California.

Kitty Wilde RN guest on KVEC Radio Show "The Best is Yet to Be"

The program will air this Saturday 9-24-10 at 12 noon on KVEC  Talk Radio in San Luis Obispo California.
Topics that were discussed today were:
Quality aging in place no matter where the location
Training for Caregivers / Care Partners - First Aid, Blood Borne Pathogens, Dementia Training and Activities of Daily Living
Medication Management
Jitterbug Cell phones - simple cell phones for Seniors
Dakim Brain Fitness - for everyone to help improved cognitive performance (memory and speed of processing)
Eden Alternative principles and the three plagues of , Loneliness, helplessness and boredom accounting for the bulk of suffering among our Elders

Deborah Bayles hosts the radio show called “The Best is Yet to Be”

Deborah thoughts on aging…It occurred to me recently that most of the articles and information out there portray aging as a disease — not a phase of life worth celebrating. I mean, after all, we should count ourselves lucky if we are among the aging. It sure beats the alternative. So I thought, what if there was a forum and a community that actually celebrated aging? What if you could make the rest of your life the best of your life? That’s how this radio show — and this website–got started.

Deborah Bayles Hosting " The Best is Yet to Be" radio show

Each week she interviews top local experts in their fields on the show to talk about various aspects of positive aging. I figure that rather than look at our future as something to be dreaded, we should enthusiastically affirm “The Best is Yet to Be!”

Click her for more info on the Radio Show ” The Best is Yet to Be” with Deborah Bayles

Click here for more KVEC 920 Radio Information

5/13/2010

SENIORS HOUSING OCCUPANCY FALLS, RENT GROWTH CONTINUES
NIC MAP Data Also Shows Shrinking of Construction Pipeline

Annapolis, Md. - Occupancy rates fell for seniors housing in the first quarter of 2010, while rent growth continued but at a slower pace than seen in the previous two years, according to NIC MAP, a data and analysis service of the National Investment Center for the Seniors Housing & Care Industry (NIC). The data for the top 31 metro markets also showed that a significant shrinking of the construction inventory pipeline continues, fueled by a combination of project openings and declining construction starts.

The average occupancy rate fell to 88.0% for seniors housing (both independent living and assisted living properties) during the first quarter of 2010, down from 88.3% in 4Q09. Specifically, the average occupancy rate was 87.9% for independent living properties and 88.1% for assisted living properties in 1Q10. In comparison, the average occupancy rate during 4Q09 was 88.2% percent for independent living properties and 88.4% for assisted living properties.

Independent living supply in the top 31 metro markets totaled 322,225 units in 1Q10, with 283,211 total occupied units. In the same quarter, assisted living supply totaled 174,010 units, with 153,330 total occupied units. The seniors housing inventory has grown 11,826 units during the previous four quarters, while absorption during that time has been 6,108 units.

“We’ve seen a general theme develop over the past few years,” said Michael Hargrave, vice president - NIC MAP. “There’s been erratic absorption over the last four quarters, and inventory growth has outpaced demand, but overall absorption has developed a marginally positive trend.”

In comparison, a long trend of negative absorption for skilled nursing disappeared in the first quarter of 2010 and became marginally positive. Skilled nursing occupancy rates rose to 89.0% in 1Q10, compared to 88.8% in 4Q09. During the previous eleven quarters, demand in this sector had consistently declined. “This was the first quarter of positive absorption in three years,” says Hargrave.

SOURCE: www.nicmap.org

Click here to read the article

Several experts have theories that Assisted Living and Residential Care for the Facilities for the Elderly (RCFE’s) occupancy has been linked to the unemployment rate.

Previous Stats ….According to the U.S. Department of Labor’s Bureau of Labor Statistics, there are nearly 31 million people currently unemployed — that’s including those involuntarily working part time and those who want a job, but have given up on trying to find one. In the face of the worst economic upheaval since the Great Depression, millions of Americans are hurting. “The Decline: The Geography of a Recession,” as created by labor writer LaToya Egwuekwe, serves as a vivid representation of just how much. Watch the deteriorating transformation of the U.S. economy from January 2007 — approximately one year before the start of the recession — to the most recent unemployment data available today.

SORUCE: latoyaegwuekwe.com

If you are an LVN and looking for a rewarding  job working with seniors in a  small private RCFE ( Residential Care Facility for the Elderly in Atascadero.  Call us!  805-452-3225 - Or fax your resume to 805-473-7405

Great Job for the right person!

E-mail resume

The Retreat in Nipomo for Senior Ladies is designed especially to be cozy, comfortable, clean and cheerful family-style living for six Residents, this upscale, well-kept home is perfect for those who require assistance with the activities of daily living (ADL), but prefer the dignity and the comfort of living in a private home.

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Master bedroom

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Sitting Room at the Retreat in Nipomo

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The Retreat’s intention is to make a positive difference in the lives of their Residents by providing home-style care in a safe, stimulating and family-oriented environment. Residents’ health and well being are their priority.

Bedroom at the Retreat

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