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Yahoo
13 hours ago
- Health
- Yahoo
The most worrying words in Trump's move on emergency abortions
In a major move on abortion policy, the Trump administration just withdrew Biden-era guidance on emergency abortions. The guidance had interpreted the Emergency Medical Treatment and Labor Act (EMTALA) as requiring access to abortion in certain medical emergencies, even in places where abortion is a crime. The revocation by the Centers for Medicare and Medicaid is unlikely to help hospitals and doctors who were already unsure how EMTALA would be interpreted or enforced. But an accompanying statement from CMS hinted at a broader change, stating that EMTALA required hospitals to prevent serious risks to 'the health of a pregnant woman or her unborn child.' Understood in this way, EMTALA under the Trump administration could further restrict how doctors address emergencies, regardless of states' abortion laws. Congress passed EMTALA in 1986 to stop hospitals from turning away patients who couldn't afford to pay, especially women in labor. In the wake of the Supreme Court's decision overturning abortion rights, the Biden administration issued guidance on EMTALA requiring hospitals and physicians participating in Medicare to provide abortions in certain medical emergencies, even in states that ban abortion. In theory, EMTALA could be a powerful check on state bans; violators could face fines and even exclusion from the Medicare program. What's more, EMTALA, a federal law, could trump conflicting state laws. In practice, it wasn't clear how much of a difference the Biden administration's guidance was making. A congressional investigation in December 2024 found that hospital lawyers were often inaccessible and offered confusing advice to doctors, even with the Biden guidelines in place. It wasn't clear how strongly the federal government would come after offenders, and hospitals had to weigh that risk against the threat of prosecution and fines in states where abortion is banned. The courts didn't help clear things up either. The two most prominent lawsuits involved the Biden administration suing Idaho over its ban (which only has an exception for the life of the mother) and Texas suing the federal government over its guidance. In both cases, abortion opponents seized on language in the statute referring to the health of 'the health of the woman or her unborn child.' Anti-abortion lawyers insisted that, under this wording, EMTALA imposed equal obligations toward pregnant women and unborn patients. When those obligations conflicted, the argument went, individual physicians would have to decide what to do, and state laws criminalizing abortion would break the tie. While the conservative Fifth Circuit sided with Texas on this question, lower courts blocked enforcement of Idaho's law. The Supreme Court agreed to step in, but ultimately dismissed the petition as improvidently granted. In an opinion by Justice Samuel Alito, however, three of the court's most conservative justices dissented, echoing the argument that EMTALA created obligations toward fetal patients and thus couldn't require hospitals to allow any abortion. There's just one problem with this theory: EMTALA's text. The original bill did not reference unborn patients. In 1989, Congress passed amendments meant to clarify the law's scope. Those amendments created two categories of emergency condition, those that did not involve labor and those that did. Almost all of EMTALA's references to the 'unborn child' fall in the latter category, where the appropriate way to stabilize a patient is to successfully deliver a baby. Only once is the term mentioned around non-labor emergencies — the category of emergencies where abortion would be considered. Simply mentioning the term 'unborn child' doesn't necessarily mean that Congress wanted to recognize fetal patients' rights. In fact, limiting mentions of the 'unborn child' almost entirely to scenarios where labor has already begun suggests the contrary. Furthermore, the use of the term hardly answers what should happen when a pregnant woman's life or health are clearly imperiled. Though the Trump administration has reinforced that hospitals have duties to fetal patients too, it has not explained how hospitals should carry out those duties. Will the administration act if a hospital doesn't prioritize the needs of the unborn patient, or strike the right balance between the fetus and pregnant woman? Anti-abortion medical organizations like the American Association of Pro-Life Obstetricians and Gynecologists have issued guidelines requiring hospitals to use 'humane medical interventions that aim for both mother and her unborn child to live when possible and do not inflict direct violence on the unborn child.' Will the Trump administration require hospitals to use these methods when addressing emergencies? Much of the debate about EMTALA so far has focused on states where abortion is banned. But if the Trump administration does enforce EMTALA to protect fetal patients, will it impose penalties on hospitals in states that protect abortion as a right? After all, though anti-abortion forces' reading of EMTALA focuses on the text of the law, that interpretation is consistent with their broader ambition: to confer constitutional rights of fetuses from the moment of fertilization. The 2024 GOP platform nodded to this theory, implying that the Fourteenth Amendment, which addresses due process and equal protection, already protects the unborn child. In Minnesota, an anti-abortion lawyer is challenging the constitutionality of the state's liberal abortion law by arguing that it violates the rights of the unborn child. Another fetal personhood suit just reached the 2nd Circuit Court, where a panel of judges appointed by George W. Bush and Donald Trump rejected the plaintiffs' claims on a technicality. At the moment, the primary effect of the administration's move on EMTALA will be more confusion for hospitals and physicians. But the administration's references to the unborn child can't be ignored. In the longer term, the end of the Biden-era guidance may be the tip of the sword further carving up abortion protections, even in states where that right is still protected. This article was originally published on
New York Post
2 days ago
- Business
- New York Post
‘Deadly' GOP ‘cuts' don't even touch Medicaid's 50% growth since 2019
As the Senate takes up the House-passed Big Beautiful Bill, the No. 1 hitch is a dispute between fiscal hawks and Medicaid doves — that is, senators who say it doesn't cut enough federal spending vs. those who claim it cuts 'too much' from Medicaid. That latter crew includes a few Republicans — and pretty much all Democrats, who keep talking about 'millions losing their health insurance' with literally deadly consequences. The hawks are a lot closer to reality here: The GOP bill doesn't actually even cut Medicaid, it just slightly slows its growth in years to come, even though Medicaid spending has exploded since 2019. Federal Medicaid outlays since 2019. Per the Congressional Budget Office, federal outlays on the program have been positively soaring, from $409 billion in 2019 to $615 billion in 2023, and projected to hit $655 billion in 2025. That's a 50% jump from 2019 to 2023, and 60% to 2025. What happened? First, a spike in emergency spending in the name of dealing with the pandemic, followed by the Biden crew's quiet drive to expand Medicaid as much as it could in the direction of 'universal health coverage.' That last included giving Uncle Sam's OK to complex state financial games to 'qualify' for billions more in 'free' federal funding. As a result, per the Centers for Medicare and Medicaid, the federal share of total Medicaid spending rose from 63% in 2018 to 70% in 2022. That dropped a bit to 68% in 2023 as most states, after years of Washington-mandated forbearance, finally started pruning their rolls of people who now make too much to qualify for what's supposed to be a program for the poor. Every time Democrats gain power in Washington, they ratchet up Medicaid outlays; Republicans for decades have flinched from rolling it back, no matter how perverse it leaves the rules. For example, the feds still cover 90% of the cost of Medicaid coverage for single men, vs. just 50% for families and women with kids in the house: The mismatch began as a 'temporary' rule when ObamaCare passed, but somehow has never ended. And it all adds up to far more than Uncle Sam can afford, and a major reason why yearly federal budget deficits are nearing $2 trillion — even though the feds keep collecting ever more in taxes. Sooner or later, it's got to stop — but the GOP budget bill only begins to rein in Medicaid's growth with commonsense reforms like requiring able-bodied single men to work just 80 hours a month to still qualify. And that rule wouldn't even kick in for a couple of years — none of the Republicans' 'savage cuts' do. Bottom line: The bill is already plenty 'dovish'; if the Senate bends it any more in their direction, it'll break the bank all the sooner.
Epoch Times
26-05-2025
- Health
- Epoch Times
DOGE Has Found $14 Billion in Medicaid Fraud, Waste, and Abuse, Dr. Mehmet Oz Says
Centers for Medicare and Medicaid (CMS) Administrator Dr. Mehmet Oz said that his agency and the Department of Government Efficiency (DOGE) have identified at least $14 billion in fraud, waste, and abuse. 'There's about $14 billion we've identified with DOGE, of folks who are duly enrolled wrongly in multiple states for Medicaid,' Oz As an example, Oz said, 'You live in New Jersey, but you move to Pennsylvania, and which state gets your Medicaid? Turns out both states collect money from the federal government.' There are other areas, he said, that constitute abuse of the federal health care system. He said that some people who are eligible to get a job or seek education are receiving Medicaid, echoing statements made by GOP lawmakers, including House Speaker Mike Johnson (R-La.) and Majority Leader Steve Scalise (R-La.). who in recent days said that able-bodied individuals and illegal immigrants have received Medicaid benefits. Oz urged that Medicaid be cleaned up so that it can provide services to individuals such as people with disabilities and others, suggesting that Republicans keep a work requirement to be eligible for the program. 'I think there's a moral hazard if we don't, because you've got people who are not working who could work, who should work, and it's better for them and better for the country if they do,' he said, referring to Republicans' having added work requirements into to the One Big Beautiful Bill Act that passed in the House of Representatives last week. Related Stories 5/23/2025 5/20/2025 Medicaid is a joint federal and state program that The bill, which is now in the hands of the Senate, would impose work requirements for low-income adults to receive Medicaid health insurance and increase them for food assistance. Supporters of the bill say the moves will save money, root out waste, and encourage personal responsibility. Starting next year, many able-bodied Medicaid enrollees under 65 would be required to show that they work, volunteer, or go to school in exchange for the health insurance coverage under the measure. Only Arkansas has had a work requirement that kicks people off for noncompliance. Established by President Donald Trump earlier this year, DOGE is tasked with finding fraud, waste, and abuse, although some of its efforts in federal agencies have been blocked by courts. A U.S. district judge in Maryland, for example, in March blocked the agency from accessing Social Security Administration systems, prompting the Trump administration to submit an emergency petition to the U.S. Supreme Court earlier this month. The task force has been effectively led by industrialist Elon Musk, a senior adviser to Trump and a special government employee, meaning he has 130 days to complete his work. Musk said during a Tesla earnings call last month that he would be stepping back from his government duties in May to focus on his company. Over the past weekend, Musk wrote in a post on X that he is now working more at his companies, including Tesla and X. 'Back to spending 24/7 at work and sleeping in conference/server/factory rooms. I must be super focused on X/xAI and Tesla (plus Starship launch next week), as we have critical technologies rolling out,' Musk Oz, a former daytime television personality and doctor known as Dr. Oz, was confirmed as the 17th Centers for Medicare & Medicaid Services administrator by the Senate in early April. The Epoch Times contacted the CMS for comment on Monday. The Associated Press contributed to this report.
Yahoo
12-05-2025
- Health
- Yahoo
Report pinpoints nursing home staffing shortages in Iowa and the nation
The Bettendorf Health Care Center, a Scott County nursing home, has been cited for insufficient nursing staff three times since May 2022 and is reported to be staffed 43.8% below expected levels based on residents' needs. (Photo via Google Earth) Newly reported federal data shows the overwhelming majority of nursing homes in Iowa and the United States are operating with too few staff to meet resident's basic needs. Eleven of Iowa's 410 nursing homes were staffed at least 40% below the level expected to meet residents' needs during the third quarter of 2024, according to the data. Among the 50 states, Iowa ranked in the middle of the pack, with staffing levels that averaged 20% below expectations. According to federal data compiled by the Centers for Medicare and Medicaid and then analyzed by the nonprofit Long Term Care Community Coalition, nine in 10 nursing homes across the country were staffed below the level expected based on resident needs. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX The report comes as Congress considers budgetary proposals that include instructions requiring the U.S. Department of Health and Human Services to delay, until January 2035, enforcement of new minimum staffing standards for nursing homes. Richard Mollot, LTCCC's executive director, said the coalition's methodology for calculating resident needs isn't based on arbitrary benchmarks, but on each facility's first-hand evaluation of its own residents' condition and medical needs. 'It gives residents, families, operators, and policymakers a clear and meaningful way to gauge whether a nursing home is adequately staffed to ensure safe, appropriate care,' he said. In the third quarter of 2024, the study shows, the average U.S. nursing home provided 3.73 total nurse staff hours per resident, per day. Based on resident acuity, the national average expected staffing level was 4.94 hours. As a result, the median nursing home fell 25% short of expected staffing levels, according to the coalition. Only two states — Alaska, where staffing levels averaged 21% above expectations, and Oregon, where the homes were staffed 2.5% above expectations — met or exceeded their expected staffing levels. The states with the worst overall staffing averages included Illinois, where the homes averaged 37.7% below expected levels, followed by Texas, New Mexico, Missouri, Georgia and Virginia, all of which were at least 30% below expected levels. The new report indicates there's insufficient data on staffing for 13 of Iowa's 410 nursing homes. Of the remaining 397 homes, 34 are reported to be staffed at or above the expected level. There are 11 Iowa nursing homes that were staffed at a level at least 40% below the expected level based on each home's assessment of residents' needs. State records show that of those 11 homes, seven were cited by state inspectors for insufficient nursing staff at some point during the past 10 years. The 11 Iowa homes that were staffed at least 40% below the expected level are: Adel Acres in Dallas County: 47.5% below. The home was last cited for insufficient nursing staff in December 2021. Oakland Manor in Pottawattamie County: 46% below. The home was last cited for insufficient nursing staff in August 2023. Aspire of Pleasant Valley in Scott County: 45.3% below. The home was last cited for insufficient nursing staff in September 2024. Mount Ayr Health Care Center in Ringgold County: 44.3% below. The home has not been cited for insufficient nursing staff in the past 10 years. Bettendorf Health Care Center in Scott County: 43.8% below. The home was last cited for insufficient nursing staff in January 2025, October 2022 and May 2022. Aspire of Perry in Dallas County: 43.1% below. The home was last cited for insufficient nursing staff in October 2024, September 2024 and September 2023. Panora Specialty Care in Guthrie County: 42.8% below. The home was last cited for insufficient nursing staff in January 2025. Good Samaritan Home of Saint Ansgar in Mitchell County: 42.7% below. The home has not been cited for insufficient nursing staff in the past 10 years. Grundy Care Center in Grundy County: 42.4% below. The home was last cited for insufficient nursing staff in November 2024 and August 2024. Maple Manor Village in Butler County: 41.4% below. The home has not been cited for insufficient nursing staff in the past 10 years. Kingsley Specialty Care in Plymouth County: 40% below. . The home has not been cited for insufficient nursing staff in the past 10 years. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
30-04-2025
- Business
- Yahoo
Inside the ‘multi-billion-dollar game' to funnel cash from nursing homes to sister companies
It's been called one of the worst nursing homes in New Jersey. For years it 'siphoned' millions of dollars of Medicaid funds out of the home and to various side businesses, a state watchdog found, 'leaving residents to live in a dismal, understaffed, and under-resourced facility.' And in December, acting State Comptroller Kevin Walsh moved to kick South Jersey Extended Care, its owner and those associated with its operations from the state's Medicaid program. 'This was a massive scam,' he said. 'These individuals were able to amass a fortune by pretending to be independent parties. In reality, they operated as one unit, providing terrible care to the sick, the elderly, and the poor, so they could make big profits.' Money that could have been used to hire additional staff, improve facilities, or enhance resident programs was instead used for owner distributions, 'consulting' fees, and charitable donations to organizations they controlled, the report said. There are approximately 15,000 nursing homes in the United States, caring for about 1.2 million people, and more than half reported operating at a loss in 2023, according to a review of the annual cost reports they file with the Centers for Medicare and Medicaid. Nursing home owners and the organizations that represent them have repeatedly said that Medicare and Medicaid reimbursements simply aren't enough. The best way to improve care for the frail and elderly, they have said time and again, is to send more taxpayer dollars their way. But some long-term-care operators across the country have become adept at the legal practice of paying related side businesses they own as well, effectively blurring where the money goes, according to advocates, critics and academic studies. And in the case of South Jersey Extended Care, they crossed a line, regulators charged. 'They siphoned funds intended for resident care to their personal and business interests, reflecting a clear case of fraud, waste, and abuse of Medicaid funds,' the comptroller said. Mark Davis is an elder care attorney in New Jersey. He said nursing homes often pay inflated costs to the related companies. He said: 'They use management entities to get money out of the facility and into the owners' pockets.' Some call that 'skimming.' Others term it 'tunneling.' Or 'funneling.' And today, most nursing homes are doing it, according to an analysis by reporters of federal cost reports. It's how a nursing home can show a substantial loss on paper, as operators shift money through deals with their own side companies. 'They use management entities to get money out of the facility and into the owners' pockets...' Illustration by Andrea Levy But such transactions are legal and by no means uncommon, industry officials point out. Martin Allen is senior vice president of reimbursement at American Health Care Association/National Center for Assisted Living, a trade organization that represents more than 14,000 nursing homes and long-term care facilities. 'Related parties are common across a variety of industries,' said Allen, 'and focusing on them among nursing homes is a red herring.' Here's how it works: More than 7 in 10 long-term care facilities, or about 78% of all nursing homes nationwide, operate multiple entities with the same or related owners, according to the cost reports they file with federal regulators. A home might rent its building from one company, pay management fees to another company and hire a third company to provide physical therapy. The nursing home business could show a loss, while the other businesses, owned by some of the same people, make money. Experts trace the widespread use of sister companies to a 2003 article in the Journal of Health Law that suggested nursing home operators split off their real estate holdings to limit legal liability. 'And let me tell you, the industry read that article because within a couple of years, everyone was using this model,' said Ernest Tosh, a Texas attorney who has testified before Congress. 'It's not uncommon for us now to go into litigation with a chain that only has 50 regional nursing homes, but it'll have 150 or 200 [limited liability corporations] at least.' Which makes figuring out where the money is going difficult. 'It takes too much effort, too many depositions. It's not worth the expense,' he added, 'so it is very effective.' But Allen said the related businesses help owners streamline services. The real problem, he added, is that the government is not paying enough. 'The sad truth is that because long-term care is chronically underfunded, ancillary services sometimes help keep these nursing homes afloat,' the trade group official said. 'But they alone cannot fix where public policymakers have shortchanged our nation's seniors.' In a paper published last year by the National Bureau of Economic Research, economists Andrew Olenski and Ashvin Gandhi estimated that in 2019, '63% of nursing home profits were hidden and tunneled to related parties through inflated transfer prices.' So what happens when nursing homes do business with sister companies? Olenski and Gandhi found that costs go up. A lot. Once a facility adopts a related party for one of these services, total spending increases by 20.4% for real estate and by 24.6% for management, they discovered. 'This may not seem like a tremendous amount of money,' said Olenski, a professor at Lehigh University in Pennsylvania, 'but when you consider just how much money these firms are spending on rents and management, it turns out that a 20 to 30% markup on your costs can really meaningfully shift your stated profit margins.' Industry officials note that such transactions aren't hidden. They are disclosed on federal and state nursing home cost reports. But the public can't see those records online. They are filed in massive data files that are difficult to parse out into individual reports. Lack of transparency is getting worse, said Stephen Crystal, director of the Center for Health Services Research at Rutgers University. He said that's due to the use of related companies under the same ownership, but also due to the increasing presence of private equity investors buying nursing homes. 'There is an obscurity built into private equity. They are not public companies, so they operate under much more of a veil,' he said. 'When you send your mom into a nursing home, they should be accountable for who that is.' For nursing homes doing business with companies under the same ownership, the federal government sets a standard for Medicare for costs that a 'reasonably prudent buyer' might pay on the open market. But that's not how those costs appear on the reports nursing homes file with regulators each year, according to Tosh, the attorney in Texas. Instead, he explained, they contain what is called the 'allowable cost' — what a related company claims it actually cost to provide a good or service. Those numbers are reported each year by the nursing homes. Operators spell out what they paid to related companies in annual federal reports. In the federal filings examined by reporters, U.S. nursing homes in 2023 reported paying related businesses billions more than what they stated to be the actual costs for those services (as listed as 'allowable costs' in federal reports). The instructions for entering the actual costs in the reports are pretty straightforward: 'Enter the allowable cost from the books and/or records of the related organization which includes only the actual cost incurred by the related organization for services, facilities, and/or supplies and excludes any markup, profit or amounts that otherwise exceed the acquisition cost of such items.' A final column shows how much each home paid related companies above that actual cost. In 2023, nursing home operators paid $2.76 billion over and above 'allowable costs' to related businesses. For example, if a nursing home operator also owns a pharmacy supply service, the cost report might show that it spent $300,000 on drugs. That's the allowable cost under Medicare. If the federal cost report indicates that the nursing home actually paid the pharmacy $500,000, the difference between the two numbers shows the pharmacy was paid $200,000 over the 'allowable cost,' said Tosh. Since both businesses are owned by the same owner, he said, that $200,000 effectively stays with the nursing home operator. But what was the actual cost? What was the fair market value? 'Nobody knows the answer to either of those questions,' said Tosh. 'There is no monitoring of related parties. The reporting of overpayments to related parties relies on the nursing home industry to truthfully report this information.' Those kinds of arrangements are no surprise to attorney Paul da Costa, who has sued several long-term-care operators over allegations of failure of care. He described the business as 'the Russian doll scenario,' referring to the iconic Matryoshka nesting dolls that stack within each other. In Ohio, the family of a man who choked to death in a nursing home filed a lawsuit questioning how much money that facility was funneling out of the facility in management fees. Ronald Wysong's family installed a camera inside his room at the Ohio nursing home soon after the 81-year-old he moved in. According to a lawsuit the family filed against Sanctuary at Wilmington Place in Dayton, he was prescribed a 'mechanically altered diet' that required his food to be pureed and minced or he would choke. 'Help me,' he muttered one afternoon, visibly struggling to breathe, as seen on a video cited in the lawsuit. A nursing aide from a temporary staffing agency handed him a bucket before leaving him alone, according to the lawsuit. When the aide returned, Wysong was unresponsive, according to the lawsuit and the video. Panic erupted as the aide started repeatedly swearing and a nurse attempted to revive Wysong using CPR, as captured on video. After more delay, the staff brought a 'crash cart' into the room. However, the suction machine it carried was not working, according to the complaint. Finally, an EMS crew arrived on the scene. Wysong, who loved photography, wood carving and fishing, choked to death, according to a pathologist's report. The lawsuit, still pending in court, alleges the nursing home's parent company, American Health Foundation 'undertook a concentrated effort to increase the number of residents in the buildings while reducing the budget and resources to such a degree that appropriate and safe care was not and could not be provided' at the expense of their residents' care. At the same time, the case questioned how much money was going out through management fees paid to the parent company. 'The management fee agreements are not arm's length transactions where both sides act independently and in their own self-interest,' they alleged in the lawsuit. That was because both parties were owned and controlled by American Health Foundation, according to the lawsuit. American Health Foundation did not return calls or emails seeking comment. But in court filings, it said that the nursing facility itself 'directs and controls day-to-day operations including staffing and nursing care,' and denied that any conduct by the facility's staff 'led to Ronald H. Wysong's pain, suffering and wrongful death.' A federal report in December raised concerns about the use of side businesses. Nursing homes from 2015 through 2020 reported receiving $160.4 billion in Medicare payments. But more than a third, $65.4 billion, of that was paid to related parties, according to the report by the Office of Inspector General for the Department of Health and Human Services. Nursing homes from 2015 through 2020 reported receiving $160.4 billion in Medicare payments. More than a third of that was paid to related parties, according to a recent report. Illustration by Andrea Levy Federal regulations state that 'related to the provider means that the provider to a significant extent is associated or affiliated with or has control of or is controlled by the organization furnishing the services, facilities, or supplies,' the report stated. And the report just looked at what nursing homes share about themselves. Much doesn't get shared. For example, in an audit of just 14 nursing homes, the inspector general found three failed to report one or more related parties on their Medicare cost reports. 'In addition, 7 of the 14 SNFs (skilled nursing facilities) did not properly adjust some of their related-party costs to Medicare-allowable costs as required, which resulted in more than $1.7 million in overstated costs,' the inspector general said. The watchdog in its report criticized CMS as well, finding that the federal agency 'did not provide sufficient guidance' to nursing homes on Medicare-allowable related-party costs. In New Jersey, the state comptroller in a report in December highlighted the potential abuse of using related businesses. At the center of it all was South Jersey Extended Care, a sprawling 167-bed nursing home located in a wooded tract off a rural, two-lane road in Bridgeton about 50 miles west of Atlantic City. The report noted that the facility was operated by Mark Weisz. However, investigators called Weisz 'a straw owner who yielded all control to his cousin, Michael Konig, and Konig's brother-in-law, Steven Krausman.' South Jersey Extended Care in Bridgeton. NJ Office of the State Comptroller Konig transferred ownership of his nursing homes in New Jersey to his cousin after he had been barred from operating nursing homes in Connecticut and Massachusetts, the comptroller reported. The arrangement allowed Konig to continue operating the facility and continue to profit through third-party companies that received contracts from South Jersey Extended Care, the comptroller concluded in a report of his findings. Those deals included a food services contract with one Konig company, National Nutritional, which received $13.9 million over a five-year period from April 2018 to March 2023. Of that, $2.8 million went into Konig's bank account, said the comptroller, who accused National Nutritional of 'significantly inflating the costs it charged to South Jersey Extended Care' to profit from the relationship. 'They decided where the money went. They handled everything,' said Walsh. 'And for almost every major contract, they hired their own businesses.' In his report, the comptroller said a review of South Jersey's contracts and invoices documented that price terms and payments 'were not based on the actual cost of goods and/or services to the related party.' That resulted in 'what appears to be extremely high profits to Konig-owned or -controlled entities, for things such as food, medical supplies, and staffing, with comparatively little spent on the actual goods or services provided to South Jersey Extended Care,' the report said. 'This arrangement obviously benefitted Konig but resulted in waste of public funds and harmed SJEC's residents.' Peter Slocum, the attorney for Konig, the nursing home and others named in the report, denied the allegations. He maintained that the third-party companies providing services did not meet the definition of 'related entities.' Slocum also said Konig had not been barred from owning nursing homes. 'He merely agreed not to purchase a new facility for a given period,' Slocum wrote in a letter to the comptroller, which he shared with Slocum added that the 'wildly defamatory accusations that (his clients) 'actively commit[ed] fraud, waste, and abuse' as part of a 'wholesale fraud upon the state and federal governments' are unsupportable.' But Walsh said his office, with the approval of the state Attorney General, 'is suspending those responsible for this conduct from New Jersey Medicaid.' They include Weisz, Krausman through his company Comprehensive Health Care Management Services, and Konig. That suspension was to take effect last week, court filings show, but has been moved to the end of May with the appointment of a receiver. The nursing home has not challenged the suspension, officials said. In April, New Jersey went to court to have a receiver appointed to take over South Jersey Extended Care's operations, determining that the home was 'in acute financial distress and/or at risk of filing for bankruptcy protection and/or at risk of an impending closure, which would have a significant adverse effect on the health, safety and welfare of the facility's residents.' A judge approved the naming of a receiver, which went unopposed by the home's operators. State records show South Jersey Extended Care is now seeking to transfer ownership. In general, nursing homes that outsource to related organizations tend to have major shortcomings, according to an analysis of inspection and quality records by KFF, a nonprofit health policy research organization. 'They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes,' the analysis found. Tosh, the Texas attorney, said staffing levels are an indicator of the quality of care. 'Staffing dictates outcomes,' he said. 'If the number is too low, you've killed off a number of old people.' He said nursing homes should be staffing based on the health needs of the residents in each facility — what is known as staffing to acuity. Those numbers are already reported to the Centers for Medicare and Medicaid Services, or CMS. But the regulators don't use them, he said. Keeping an eye on industry financial practices, meanwhile, can be difficult, say some advocates and regulators. 'The history of attempting to ensure nursing homes don't divert money away is a multibillion-dollar game of 'Whac-A-Mole,' in which the government regulates and the industry adjusts,' said Walsh, the New Jersey state comptroller. 'Greed is at the heart of the problem,' he added. Acting New Jersey State Comptroller Kevin Walsh Courtesy of the Office of the State Comptroller In New Jersey, Walsh has been ushering in a more aggressive approach to policing poorly performing nursing homes by urging the administration of Gov. Phil Murphy to withhold Medicaid funding from nursing home owners that receive one out of five stars from the federal government based on quality and staffing. Nationally, what can be done? The feds could set standards. They could set requirements for how much money is spent on food for residents, said Charlene Harrington at UC San Francisco. The feds could also set limits on how much money goes to administration or rents or profits. Harrington said it's not clear that government regulators have any idea how long-term care facilities are spending Medicaid dollars, or how much operators are profiting. 'The regulation of nursing homes is a disgrace,' she said. The U.S. Centers for Medicare and Medicaid Services could conduct random audits on facilities, suggested Richard Mollot, executive director of the Long-Term Care Community Coalition. 'There is a lack of urgency when it comes to resident safety and program integrity, and a domino effect of failure after failure after failure to take resident harm seriously. At every level in my experience and what I see in the data, there is a disregard for the lives of people in nursing homes and assisted living facilities,' Mollot said. Federal regulators could also audit the cost reports nursing home operators file each year. 'They just let it go into a giant database to never be seen again,' said Tosh. Inspections could be improved. Or even conducted in the first place. Nationwide, routine inspections are not happening in many nursing homes because of delays and understaffing at the state level. More than 20% of the nation's 15,000 nursing homes were behind on comprehensive annual inspections, reporting shows. One in 10 have not received an annual inspection in two years or more, according to CMS data reviewed by reporters. But federal regulators in charge say they don't have enough money to do more. A spokesman for the Centers for Medicare and Medicaid Services said annual funding to conduct health and safety inspections has not changed over the last nine years. Yet, the spokesman acknowledged that the number of complaints has 'sharply increased' in recent years. And there aren't enough inspectors at the state level. The U.S. Senate Committee on Aging in 2023 found more than half of the inspector jobs were unfilled in nine states. And employees sometimes know to prepare for inspections anyway, according to a lawsuit by the U.S. Justice Department . 'The facilities often had some sense of when a survey could occur, which gave the facilities a chance to prepare for scrutiny,' said federal prosecutors looking into one home in Pennsylvania. A week after an inspection by the state, prosecutors said, a worker sent an internal email to another mocking the state inspection: 'Ain't nobody faker than a nursing home when the state is in the building… #Factz.'
