Governmental Enforcement of Quality of Care Standards

The Federal government continues to enforce quality of care standards in long-term care facilities through the use of fraud and abuse statutes. Two of the most potent weapons the government has are administrative imposition of civil monetary penalties and legal remedies under the false claims act.

$14,000 Civil Monetary Penalty

A nursing facility's 12-hour delay in notifying a physician that a resident's temperature rose to 105.10 F resulted in a civil monetary penalty. The original civil monetary penalty imposed by the Health Care Financing Administration (HCFA) was $217,500. This was reduced on appeal to $14,500. The underlying basis for the fine was HCFA's finding that the facility failed to comply substantially with the requirement that each of the facility's residents receive "the necessary care and services to obtain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with a comprehensive assessment and plan of care." The incident was uncovered upon completion of a survey of the facility. The fine imposed was a per-day civil monetary penalty beginning on the date of completion of the survey and continuing until the date of the follow-up survey that found the facility to be in compliance. Lake City Extended Care Center v. Health Care Financing Administration, DHHS App. Bd. Decision No. 1658.

Injunction and Damages for False Claims

The United States Attorney's Office recently filed a civil false claim action alleging that a Maryland Nursing Home provided substandard care. The action seeks injunctive relief and damages. The action followed an interim site visit by state surveyors at the request of the U.S. Attorney's Office, one month after the nursing home certified that it was in compliance with program requirements. Although the quality of care problems were discovered in an earlier survey, following the nursing home's certification both HCFA and the state agency decided not to terminate the nursing home from program participation. Nevertheless, the U.S. Attorney's office went forward with another inspection. United States v. Greenbelt Nursing and Rehabilitation Center, D. Md.

Jim Taylor concentrates his practice in health care law with an emphasis on transactional and regulatory issues. He is a member of the American Health Lawyers Association and the Arizona Association of Health Care Lawyers.