While negotiating with Republicans, President Obama has made it clear that he is not willing to cut services to Medicare patients. But he will consider trimming payments to nursing homes.
Wait a minute—doesn’t that mean fewer services for nursing home patients? Not necessarily.
Fat Profit Margins
Over the past ten years, investment groups have been gobbling up nursing homes. By 2008, over 67 percent were operating “for profit.” And insofar as that is their mission, they have succeeded, handily. The Medicare Payment Advisory Commission’s (MedPAC’s), March 2011 report to Congress notes that “In 2009, the average Medicare [profit] margin for freestanding Skilled Nursing Facilities (SNFs) was 18.1 percent. . . We examined relatively efficient SNFs,” the report adds, “and found that it is possible to have costs well below average, above-average quality, and more than adequate Medicare margins.”
In other words, there is money to be saved within the nursing home sector without undermining patient care.
But perhaps 2009 was just an unusually good year for the industry? Not according to the Center for Medicare Advocacy. Nearly two years ago the Center pointed out that: “Year after year multiple reports by the Government Accountability Office and the MedPAC have shown that the Medicare program overpays skilled nursing facilities by billions of dollars. For seven years in a row, MedPAC reported that aggregate profit margins for freestanding nursing facilities exceeded 10%. In 2007, the profit margin was 14.5%."
Meanwhile, “The nursing home industry is scaring residents, telling them that health care reform will lead to poorer quality of care and the loss of the staff who provide them with essential care each day. ‘This outrageous misinformation campaign must stop,’” added Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman.
“Worse yet, despite enormous overpayments, the Centers for Medicare & Medicaid Services documents that nursing facilities have not increased their staffing. Where do these billions of dollars go? ‘The overpayments go to profits to corporate nursing homes and to excessive executive compensation, not to the care and services needed by residents,’” said Ms. Edelman.
Linking Payments to Quality of Care
One way President Obama might cut Medicare payments to Skilled Nursing Facilities without hurting patients would be to restructure the payment system so that Medicare is reimbursing, not for the number of therapy services that a patient receives, but for better outcomes: lower infection rates, fewer preventable re-hospitalizations, better performance during health inspections and higher nurse to patient ratios.
In its March 2011 report, MedPAC recommended doing just that by “establishing a quality incentive payment policy for SNFs.”
At present, too many patients are receiving subpar care in understaffed facilities. In 2011 U.S. New & World Report surveyed the more than 15,500 nursing homes in the U.S and spotlighted those that received “four straight quarters of perfect five -star rating from the federal Centers for Medicare and Medicaid Services in health inspections, nurse staffing, and quality of care, the three areas in which CMS evaluates these facilities.” Just 18—out of 15,500—made the “Honor Roll.” Only one of the 18 was a for-profit.
Padding Medicare Bills
While many nursing home bills are paid by Medicaid, Medicare covers as much as 100 days of nursing-home services for beneficiaries who require skilled care or rehabilitation following a hospitalization of at least three consecutive days. In fiscal year 2010, Medicare spent $26.4 billion on SNF care.
Unfortunately, some of that $26 billion went to pay bills that had been “padded.”
In January Bloomberg reported that “for-profit nursing home companies led by Kindred Healthcare Inc. and Sun Healthcare Group Inc. are likelier than non-profit counterparts to overbill Medicare for the costliest services.” According to a study released by the inspector general “Medicare should investigate instances in which companies keep patients longer, charge more for care and classify clients for more extensive and costly services than needed. The findings, based on audits of nursing-home billings from 2006 to 2008, ‘raise concerns about the potentially inappropriate use of higher-paying’ billing codes, said the report by the Health and Human Services Department’s Office of Inspector General. It recommends that Medicare, the U.S. health insurance program for the elderly and disabled, consider changing its payment method for nursing home services.”
The report revealed that Medicare plans to target an undisclosed list of nursing homes with “questionable” billing practices. The program specifically is examining “special-nursing facilities” for patients recovering from an injury or who are disabled.
Granted, under the Patient Protection and Affordable Care Act (PPACA) Medicare already will be shaving future increases in reimbursements to skilled nursing facilities by 1 percent a year, gradually, over a period of 10 years. If, in a given year, nursing homes normally would receive an adjustment from CMS that lifted payments by 2 percent, under the PPACA their reimbursements would rise by just 1 percent.
But given the level of profits that the average nursing home enjoys, and the number of preventable errors and infections that inspectors have found in these facilities, a combination of trimming annual hikes in payments while moving to a system that pays for quality, not quantity, would reward the best homes, while penalizing those that have been “upcoding” their bills.
Just as I thought.
Our family went through the nursing home scene when my mother needed a “higher level of care” and had no assets. Medicare pays the first 100 days of “rehabilitation” in a SNF but only on a physician’s order following three days in a hospital. Patients are covered 100% for 100 days. Day #101 and beyond the patient becomes a “resident” is deemed “custodial.” Thereafter, only medical needs are covered by Medicare. At that point non-medical expenses are either private pay (long-term care insurance or other assets) or Medicaid.
By then my mother had recovered from a broken arm and adjusted to the new environment. She was ambulatory, made her own bed, was not incontinent, navigated to the dining room by herself, took part in activities and had a generally rewarding life in a safe, secure environment.
As far as I could tell she was a cash cow for the facility. She would have been an excellent candidate for assisted living, but Medicaid does not pay toward that, and she had no income or assets except a small SS check. (Incidentally my sister and I were very impressed with the care she received. This was a first-class not-for-profit place with plenty of staff, many with decades of seniority, and excellent food.)
It’s no wonder private companies are snapping up SNF’s. The same thing seems to be happening with assisted living facilities. I worked for one briefly before becoming an agency caregiver. There is money to be made in both areas, assisted living and SNFs. And I’m sure you are aware of the growing number of CCRCs (continuing care retirement communities) being developed across the country.
John –
According to the Medicare website, Medicare will only pay in full for the first 20 days of SNF care for each benefit period following a hospitalization of at least three consecutive days. For days 21-100, the patient or the family is responsible for paying up to $128 per day with Medicare paying the rest.
Maggie —
I agree with the thrust of the post that nursing home profitability is greater than it needs to be for Medicare patients. Custodial care for Medicaid patients is paid at much lower rates with private payers somewhere in between. I remember when my father first went to a nursing home following hip replacement surgery, his group therapy sessions were billed at $39 per 15 minute time unit in 2000 and there were quite a few sessions and at least a dozen patients in his group when I visited.
Interestingly, though, according to a former senior CMS official I met with recently, the profitability of home health agencies often exceed 30% of revenue. In Dallas alone, there are over 600 home health agencies. It’s a lucrative business segment for sure. If the Obama Administration wants to save some money within the Medicare program, it should look there as well as at skilled nursing facilities.
Barry—
The administration is looking at Home Heatlh Care agencies (as has MedPAC).
This is why the Affordable Care ACt cuts updates (annual increases) to Home Helath Care Agencies by 1% a year for the next 10 years.
Health Reform legislation does so many basicaly wise things. This is why thebill is so long. A great many details, with God (or at least the good) in the detais)
Understandably, most people don’t have the time to read it and absorb it all. That’s not their job.
But I am frustrated that so many critics of the bill seem never to have read it –or just misrepresnt it becuaus they want to knock it.
Please understand, I am not referring to you.
But I suspect that some of your impressions about what the bill does and doesn’t do are based on reading what critics say about the bill— leaving out what it is doing with Home Health Care Agencies, Nursing Homes, etc.
John–
I’m glad your mother was lucky enough to find herself in a good non-profit nursing home.
All of the research suggests that the non-profits are more patient-centered. This is a no-brainer. They just don’t have to struggle with the same build-in conflict of interest between making profits for shareholders and giving patients the best care possible.
Ultimately, I think we need to move more of our health care dollars to paying for home-based long-term care (with very good regulations and inspection) and community-based homes (again,with inspection, etc., for the many elderly who don’t own a quiet, clean home where they could get good, safe care from relatives or others.)
I’ve worked in several Kindred and Sun facilities as an agency nurse over my career, or seen their patients transferred to the ER where I was working.
I have yet to see one of their facilities that wasn’t a hell hole.
my husband was a prisoner at kindred hospital in melbourne fl. where he was kept on a ventilator that was medically unnecessary so that the profits would continue to grow. With their thoughts only on profit-patients were not weaned off vents or physically rehabilitated but were turned into physical zombies as management fought to keep them on the vent as the company profits increased and the patients health rapidly declined . Thanks to our wonderful governor, trying to get any state agency to do a full investigation was entirely useless. Never go to a Kindred facility-RUN FOR YOUR LiFE And don’t expect them to be accountable for their criminal activity as long as Rick Scott is governor
Joyce–
Thanks for writing. I am very, very sorry to hear about what happened to your husband.
I’m afraid that corruption in Florida’s health care system is an ongoing story. And, as you
say, the story is not likely to change as long as Rick Scott (who presided over the largest case of Medicare Fraud in Medicare’s history) remains governor. (Anyone interested in Scott’s story should “Search” his name on HealthBeat.
interesting piece of info..
My uncle owns 10 nursing homes in UK
It is amazing that there some question of profitability in a 10-14% profit range. Sounds like communism to me when you question whther we decide which facility we want, and their pricing can certainly be a factor. Is the government telling Google or Microsoft what they are permitted to earn?
Hoyt, this is not an issue of “Big Government” trying to squeeze private enterprise. Rather, it is an issue of taxpayers being squeezed for these healthcare costs. The middle class is endangered of being taxed out of existence because of these transfer payments. I work in a for-profit (not for much longer) SNF, and I can honestly state that this article is on the money. My company staffs as minimal as possible in order to be barely in compliance. When the surveyors come thru the facility, several “Tags” (fines) are always levied, but not so many as to jeopardize operations (ie; IJ tags-immediate jeopardy), and the cost of these fines are factored into the staffing equation (basic Economics 101-ie cost/benefit analysis). Moreover, many of these medicare charges are for dump-cases. That is, family members could care for the resident at home, but they don’t want the inconvenience and associated expenses. Given the aging baby-boomer generation, these costs have to be reduced or we will lose the middle class.
I think United States also should introduce health care system like UK, called socialized medicine, where Govt. takes care of health care for at least the poor and needy.
Just following up on Hoyt’s comment. It never ceases to amaze me how the Left despises profit(s) in any manner. The Gov’t should do more to reduce fraud and abuse rather than just cut funding for those in need, but wait, that would mean the Gov’t would be more efficient!! How would that work!!
Barry,
Thanks. I stand corrected. I forgot about the supplemental AARP policy she had which was picking up the daily rate for days 21-100.
Regarding home health agencies and hospice, my observation as a non-medical private-duty caregiver is that these agencies must be a gold mine. I see all kinds of nurses, therapists, even an occasional psychiatric worker in my work. And when my mother’s Dx indicted she would be a candidate for hospice, I thought it meant a change of protocol. Silly me. I learned there are a raft of hospice companies in my area competing for the business. Medicare pays up to four thousand dollars toward hospice! The facility where my mother was had me choose among five they knew about.
That “up to” part may be redundant. My guess is that once enrolled the company will discover a way to bill out the entire amount unless the person dies in a very short time.
As far as I could tell my mother was already receiving maximum attention in the nursing home and the hospice people, coming and going with their clipboards and satchels, were mainly… frankly I don’t know what they did, other than offer a few more words of comfort and send out memorial and aftercare notices up to a year later.
John –
Thanks for the comments on the home health agencies. As it happens, an article on HealthNewsDigest.com yesterday said that Medicare will propose a 3.35% reduction in payments to home health agencies for 2012. You can read the article here:
http://www.healthnewsdigest.com/news/health%20care%20reform0/CMS_Proposes_2012_Medicare_Home_Health_Payment_Changes.shtml
Maggie (or anyone who knows), what is the status of the CLASS Act portion of ACA?
Last I read the arithmetic was too shaky to proceed and it was sent somewhere for revision and/or correction. (It may have been victim to the Catfood Commission.) That part of the legislation struck me as among the most important provisions, providing a modest discretionary cash disbursement directly to a qualified beneficiary. Funding was to be a payroll deduction with an “opt-out” for anyone not wanting to participate (yet).
Hoyt–
Nursing homes are very different from Microsoft and Google.
First, no one has to buy Microsoftr & Google’s products.
If you’re 94, suffering from dementia, unable ot bathe and clothe yourself, and have no living relatives able to care for you, you either go into a nursing home or lie down and die on the street.
Thus, we have an interest in trying to make sure nursing homes are affordable, just as we have an interest in making sure that gas & electricity are affordable (so people don’t freeze to death in the dark.)
Secondly, and perhaps more importantly, the government buys most of the nursing home industry’s products. Very few people can afford long-term nursing home care out of pocket. Medicaid and Medicare pay the lions share.
This means that the taxpayers who fund Medicare and Medicaid are paying for nursing home care. They cannot afford to over-pay so that a small cadre of greedy nursing homes operators can make 18% profits.
Finally, all of the studies show that care is best in non-profit nursing homes: fewer infections, fewer medication mix-ups, less abuse of patients, better staffing, fewer preventable deaths, fewer preventable readmissions to hospitals.
As is so often the case, the profit motive creates a conflict of interest.
Maggie, I couldn’t have said it better. I am a nurse, new to SNF nursing, and can’t wait to get back into hospital nursing.
The Carlyle Group restructured its take-over of Manor Care, which comprised about 300 corporate entities that could obscure ownership and make it more difficult to regulate care. It split the company’s real estate holdings from the rest of the business so the properties could be used as collateral to raise funds in credit markets.
Ownership structures with multiple stakeholders have been used by other private-equity firms to minimize liabilities and shield them from regulator inquiries like when cutting staff is made to improve profit margins. They use these kinds of structures to avoid taking responsibility when taking control of nursing homes.
Private equity is buying up this industry and then hiding the assets, and when residents are dying from lack of proper care, there is little the courts or regulators can do, while they skim off the profits to line the pockets of investors or plow the money into separate ventures that have nothing to do with nursing home care.
The for-profits are taking over hospices the same way they have taken over nursing homes. The Kaiser Network noted that hospice care was designed to be delivered mainly by not-for-profit groups with affiliations to religious and community groups, but the June 2008 MedPAC report found that since 2000 mostly for-profit companies and hospices have been providing such care.
Manor Care operates hospice under their for-profit nursing homes as Heartland Hospice Care. On top of receiving an additional $130 a day for hospice service, above the daily payment they receive providing nursing home care, they take donations to their Heartland Hospice Fund.
For-profit hospices, like for-profit nursing homes are run by corporations the are coldly efficient, according to a leading palliative care specialist. If there is a way to play the system to make a higher profit, they will. Nursing home residents are already receiving 24/7 care. The hospice service is an additional $130 a day the home receives.
Another way these for-profits increase revenue is when a Medicaid resident goes to the hospital for (let’s say) a urinary tract infection for four days, and is readmitted to the nursing home, they are placed on Medicare-only status for up to 80 days, at a much higher rate of reimbursement.
The only Plan of Care that is recognized is a decreased functional mobility secondary to a recent urinary tract infecton and hospital stay. The goal is for the resident to ambulate, transfer and perform bed mobility. The only intervention is for skilled physical therapy five times a week.
But there are no other interventions to prevent urinary tract infections. So, near the end of the 80 day period or when the resident has reached their plateau of physical stamina, the resident is taken off of Medicare-only and place back on Medicaid.
If another urinary tract infection occurs, and the resident uses up the allotted time period to meet physical therapy plateu standards, the resident cannot stay on Medicare-only even though the urinary tract indications are not resolved.
Any ancillary services provided due to the hospitalization would also be more renumerative to the company if those services are owned by, or are shell companies belonging to the company (even when they do not pertain to the medical indication).
Whether those ancillary services are independent of the company or not, they are an additional cost burden on residents and/or government programs.
The previous administration shut off a source of information about abuse and neglect in long-term care facilities that people suing nursing homes consider crucial to their cases. The change, which affects the $144 billion nursing-home industry, was enacted with no public notice or attention.
The rule designates state inspectors and Medicare and Medicaid contractors as federal employees, a group usually shielded from providing evidence for either side in private litigation.
The restrictions affect about 16,000 nursing facilities and 3 million residents in the United States. The practical effect is to force litigants to go to greater lengths, including seeking court orders, to get inspection reports or depositions for cases they are pursuing or defending.
Hoyt
If your for-profit nursing home wants profitability in the 10-14% profit range, don’t expect the government to pay you this. This money goes to resident care, not to pad your corporate payrolls.
Gregory, the SNF I work for has their own hospice division. The scam is that the hospice staff come to the SNF for 30 minutes/day at most, but the SNF nursing staff are caring for the hospice resident. This is double dipping and should not be allowed.
Cutting medicare payments to Nursing Homes did not cut the profit margin of the owners. They only cut the number of Nursing staff to patient ratio, indirectly cutting quality of care to all the Nursing Home residents
Safe staffing laws would fix that problem, as would payments based on outcomes.
Panacea, John, Gregory, RV Nurse, Panacea
Panacea–I’ve gotten feedback from someone else working for oneof these chains who wrote about high staff turnover because staff are frustrated with working conditions.
John– Unfortunately, for-profits have also begun to take over the hospice industry. A source has written a very good piece for a law journal about their practices . . . I hope to write about it soon.
Barry– Yes, Medicare is cutting payments to Home Health Agencies–another area where the Medicare Payment Advisory Commission;s (MedPAC) reports suggest that payments should be trimmed.
Gregory– very interesting.
I knew about the Carlyle Group. But the change in the law which prevents inspectors from testifying against them is something I hadn’t heard about.
Could you send me any written information you have about this?
RV Nurse–
If Medicare’s system of payment is changed so that it is paying for quality, than a nursing home that cut staff would be penalized financially, and ultimately Medicare could refuse to do business with any nursing home that violates staff per patient ratios. This means the nursing home would have to close down.
Panacea- yes, exactly, Medicare needs to begin to pay for quality.
This article is very interesting and draws many parallel’s to an article I just read http://www.beckershospitalreview.com/news-analysis/wsj-lack-of-cost-sharing-drives-medicare-utilization.html. This article discusses the issue that arises from those who receive medicare utilizing care services significantly more than those who have private medical coverage.
In support of your point that there is money to be saved within the nursing home sector without undermining patient care, you mention that MedPAC’s March 2011 report notes that “In 2009, the average Medicare [profit] margin for freestanding Skilled Nursing Facilities (SNFs) was 18.1 percent.
I believe this figure reflects only a portion of the overall average profit margin for freestanding SNFs because Non-Medicare margins such as the sum of net profit (or loss) on private-payer, Medicaid, self-pay, and charity cases, as well as non-patient revenues and costs must also be included. Once this is included, the profit margin may be much smaller or even non-existent. Given this, Obama’s inclination to trim Medicare payments to SNFs could very well adversely affect patient care.
Jesse–
A good question.
But the problem is that Medicare is overpayng. The most lucrative nursing homes (top 10%) are making 34% profits on Medicare.
Medicaid payments and margins are much lower.
Nevertheless the nursing home industry is doing quite well:
The real question is should we be raiding Medicare to make up for lower Medicaid payments?
MedPAC addresses the question:
“Industry representatives contend that Medicare
payments should subsidize payments from other
payers, in large part Medicaid. However, the
Commission believes such cross-subsidization is
not advisable for several reasons. First, on average,
Medicare payments account for less than a quarter
of revenues to freestanding skilled nursing facilities.
A cross-subsidization policy would use a minority
share of Medicare payments to underwrite a majority
share of states’ Medicaid payments. Second, raising
Medicare rates to supplement low Medicaid payments
would result in poorly targeted subsidies. ***Facilities
with high shares of Medicare payments—presumably
the facilities that need revenues the least—would
receive the most in subsidies from the higher Medicare
payments, while facilities with low Medicare shares—
presumably the facilities with the greatest need—
would receive the smallest subsidies. *** Third, increased
Medicare payment rates could encourage states to
further reduce their Medicaid payments and, in turn,
create pressure to raise Medicare rates. In addition,
a Medicare subsidy would have an uneven impact
on payments, given the variation across states in the
level and method of paying for nursing home care.
In states where Medicaid payments were adequate,
the subsidy would add to excessive payments. Last,
higher Medicare payments could further encourage
providers to select patients based on payer source or to
rehospitalize dual-eligible patients to qualify them for a
Medicare-covered, higher payment stay
Jesse–
A good question.
But the problem is that Medicare is overpayng. The most lucrative nursing homes (top 10%) are making 34% profits on Medicare.
Medicaid payments and margins are much lower.
Nevertheless the nursing home industry is doing quite well:
The real question is should we be raiding Medicare to make up for lower Medicaid payments?
MedPAC addresses the question:
“Industry representatives contend that Medicare
payments should subsidize payments from other
payers, in large part Medicaid. However, the
Commission believes such cross-subsidization is
not advisable for several reasons. First, on average,
Medicare payments account for less than a quarter
of revenues to freestanding skilled nursing facilities.
A cross-subsidization policy would use a minority
share of Medicare payments to underwrite a majority
share of states’ Medicaid payments. Second, raising
Medicare rates to supplement low Medicaid payments
would result in poorly targeted subsidies. ***Facilities
with high shares of Medicare payments—presumably
the facilities that need revenues the least—would
receive the most in subsidies from the higher Medicare
payments, while facilities with low Medicare shares—
presumably the facilities with the greatest need—
would receive the smallest subsidies. *** Third, increased
Medicare payment rates could encourage states to
further reduce their Medicaid payments and, in turn,
create pressure to raise Medicare rates. In addition,
a Medicare subsidy would have an uneven impact
on payments, given the variation across states in the
level and method of paying for nursing home care.
In states where Medicaid payments were adequate,
the subsidy would add to excessive payments. Last,
higher Medicare payments could further encourage
providers to select patients based on payer source or to
rehospitalize dual-eligible patients to qualify them for a
Medicare-covered, higher payment stay
Jesse–
When I said that the nursing home industry remains quite lucrative, I meant to insert this from the MedPAC report:
For homes that sold, the median price paid
per nursing home bed increased 18 percent between 2008
and 2009 (Irving Levin Associates Inc. 2009, Irving Levin
Associates Inc. 2010). This increase reflects the fact that
well-run facilities, especially those with a high Medicare
patient mix and located in markets close to hospitals, are
a steady investment.”
Of course not all nursing homes are well-run, and not all are well-managed.
Those that have a large percentage of Medicaid patients are more likely to be a) in financial trouble and b) poorly run.
Nursing homes would rather take Medicare patients. The ones that cannot attract as many Medicare patietns are the ones that you and I would not want to be in.
The ultimate answer, I think, is to merge Medicare and Medicaid, and have them pay the same rates for all services. There is no logical reason to pay caregivers less for caring for the poor.
This would mean the federal govt’ taking over Medicaid and billing states for some portion of the cost (probably based on the number of Medicaid patients in the state, and cost of nursing home care, hopsital care, etc. in that state.)
If we did this, Medicaid margins would be better, but Medicare margins would be lower than they are now-= hopefully nursing homes would be more equal in terms of quality. (Though some that are poorly run simply need to be shut down.)
We also coudl save moeny–and in many cases provide better care–by paying for more home health care. The problem is that there has been a lot of fraud in that industry . . We need to clean it up before expanding it.
Finally, many patients who aren’t terribly sick could get better long-term at a lower cost if they were in group “community homes” that didn’t try to offer “skilled nursing” but did offer comfortable, clean surroundings, good nutrious food, and kind and caring counselors/caregivers.
They would need to be inspected regularly.
Thanks! I very much agree that the real question is whether we should be raiding Medicare to make up for lower Medicaid payments. I also agree with your idea about merging Medicare and Medicaid, but not about having them pay the same rates for all services. I think there is a logical reason to pay caregivers at different rates because the care needs are different for “rehab” care versus custodial. Linking payments to quality of care measures for rehab and custodial care needs would address this and since the future is here in terms of doing this in acute-care settings, I see every reason to do the same in long-term care.
I have written countless reviews of the horrible, for profit, Kindred Healthcare (i.e. Kindred hospital, Kindred Corp. no. 7 llc., and most recent name change Kindred TRANSITIONAL Care. The last name change after my family picketed Kindred a year and a half ago, where we were immediately approached by 5 people who exited the hospital solely with the purpose of asking for help for their family members confined in Kindred that had each been visiting when they saw us picketing in front of the hospital. The first lady who approached us was alerted by a family member who passed as us as she exited Kindred and who was aware that the lady who approached was experiencing the same consequences that my husband Michael had experienced at Kindred when he was held “captive” there(literally-from 3/13/ 12-5/1712 until our picketing got him moved). This lady told the same horroring stories of being lied to by a “salesman” who approached her when her husband was a patient in an acute care hospital where he was recovering from a stroke. The same lies that were told to her had been told when by this salesman were also told to us by my husbands doctor when he was transferred to Kindred for “aggressive rehab”and would be home in a few days. Her husband was still there several weeks later. There was no rehab being done. His condition was now becoming very serious under Kindreds care, or lack thereof, he was being kept sedated to near coma levels on pain medication he did not need and he and she had both ordered to be stopped. ( that doesn’t work at this death camp-they are totally in charge of you or your loved one’s destiny) Her husband was left lying in his own waste as no one would come to clean him up,developed bed sores, calls for any assistance were left unanswered, and of course, Kindred would not allow him to be transferred as his medical condition continued to deterioate. The other 4 ladies who approached us, (each visiting a separate family member), had the same complaints and no one would help them either. The only good news I can report is, right after we met these people on the picket line, we were advised by a hospital employee, their family members were transferred out of Kindred, The CEO, Angelica Cotshott,, left the state, no longer practicing hospital medicine in any capacity , and Dr. Anthony Michael Santilli, the Medical director at Kindred, who had been directly responsible for the ventilator fraud and false imprisonment of my husband left Kindred. He no longer has a medical license in Fl. nor any other state according to authorities. Also, according to the state attorney’s office, Mike (last name not available) who was the respiratory therapist at Kindred who slapped, taunted, and tried to suffocate Michael on several occasions and whose actions, although reported to administration and DCf, were ignored no longer has a therapists license in Fl. Someone did listen apparently because we did not go away. Hopefully , lives were saved. unfortunately, recent reviews of Kindred and pleas for help, show that Kindred is still allowed to operate under the false guise of a Medical Facility, gaining immense wealth (Fortune magazine recognizes them as one of the top-health care providers in the United States) and Medicare still allows them the lucrative ACO status that awards them even more (up to 6o % more than non ACO hospitals) then it pays non ACO hospitals. I t is important to note that Kindred was originally called Vencor, a hospital forced into bankruptcy in 1999 due to Medicare fraud and abuse and emerged as Kindred in 2001, with many of the same administrators that had been employed at Vencor. Those administrators are still at Kindred today yet, in 2012, the same CMS that had found Vencor guilty of Medicare fraud, awarded them this large contract under their new name (KINDRED) Marylin Tavaneer, the Secretary of the CMS, was the one who awarded this contract to Kindred. Not surprising, she had been an officer at the corrupt HCA ( Gov. Rick Scotts’s fraudulant hospital ) for approx. 20 years before she was appointed as an interim Secretary by George Bush in 2008. She did step down earlier this year (2015) with no explanation but it is important to note that Kindred(at least the one in Melbourne Fl.) as well as many other ACO’s she had approved , had reached the end of their trail period and now were eligible to be locked in to this Lucrative, profitable contract which allowed them to keep profiting from the Medicare payments they would be allowed to continue receiving for the abuse, fraud and death they continued to administer to these unsuspecting Medicare recipients. Another interesting note regarding this abuse in Florida is that our secretary of ACHA, Elizabeth DUDEK, who is responsible for investigating and stopping these crimes yet refuses to do anything about them, and even allows complaints to disappear, was also employed by the fraudulant HCA, (governor Rick Scott’s hospital) and was appointed by that same Rick Scott to investigate fraud and abuse as the head of Ahca in Florida. Is there no reason to question why this continuation of fraud and abuse is allowed to continue ?