Medicare Compliance & Reimbursement

ENFORCEMENT:

Quality-Of-Care Lapses Cost Wisconsin Home

Relaxed staffing requirements lead to record settlement.

A resident's death can put a nursing home in the hot seat if investigators find the facility has let staffing requirements slide.

Milwaukee, WI-based Lakeside Nursing and Rehabilitation, formerly operated by Extendicare Homes, Inc., is in just such a hot seat. Numerous violations there led to the death of an elderly resident, according to Wisconsin Attorney General Peg Lautenschlager.

Prosecutors say Extendicare has now agreed to pay $2.3 million - the largest settlement ever won by the state's Medicaid Fraud Control Unit.

The Wisconsin Department of Health and Family Services launched an investigation in 2002 after an elderly resident died from sepsis due to bedsores. The investigation allegedly revealed that bedsores on numerous residents had progressed to the point of causing serious injury.

Lautenschlager alleged that the quality-of-care problems stemmed from years of unchecked staffing problems such as insufficient staff available to reliably supply services, failure to provide assistance with personal hygiene and bathroom needs and inaction on behalf of the home's corporate offices to bring in additional help.

Lesson Learned: The cost of meeting Medicaid staffing requirements may pale in comparison to the cost of settling with prosecutors.
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