IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF PENNSYLVANIA

UNITED STATES OF AMERICA,

Plaintiff,

v.
CHESTER CARE CENTER BISHOP NURSING HOME MANCHESTER HOUSE NURSING & CONVALESCENT CENTER THE BISHOP NURSING HOME, INC. and COMMONWEALTH REAL ESTATE INVESTORS

CIVIL ACTION NO. CiF-t:.// -/37
. .

Defendants.

CONSENT ORDER AND JUDGMENT
The United States of America ("United States") and defendants, Chester Care Center, Bishop Nursing Home, Manchester House Nursing & Convalescent Center, The Bishop Nursing Home, Inc. and Commonwealth Real Estate Investors ("defendants"), have consented to the issuance of the following order subject to the approval of the Court:
JUlUSDICTION AND VENUE
1. The United States and defendants agree that this Court has jurisdiction pursuant to 28 U.S.C.A. §§1331, 1345 and 31 U.S.C.A. § 3729; that venue lies in this judicial district pursuant to 28 U.S.C.A. § 1391 (b) and (c); and that the parties will be bound by the terms of this Consent Order and Judgment.

u.s. v. Chester Care Ctr.

~~ "II~lllln~

1

FACTUAL BACKGROUND
2. The United States alleges that from June 1995 to the present, the defendants submitted, or caused to be submitted, claims for services rendered at Chester Care Center and Bishop Nursing Home on behalf of nursing home 'residents, to the government in violation of the False Claims Act, 31 U.S.C. §3729
et~
3. The United States alleges that from June 1995 to the present, the defendants submitted, or caused to be submitted, claims for services rendered to residents of Chester Care Center, and Bishop Nursing Home in deliberate ignorance and/or reckless disregard of the truth of those claims regarding their failure to provide adequate nutrition, adequate nursing care to residents with diabetes, adequate monitoring of water temperatures, adequate wound care and adequate staffing, as required by state and federal law and regulations. The Health Care Financing Administration (HCFA) imposed civil money penalties against defendants oased on deficiencies found at Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center. HC~has.also notified Chester Care Center that, if it is not i~substantial compliance with Medicare requirements by January 14,,1999, it will be terminated from the Medicare Program.
2

4. The defendants believe that the claims submitted to the United St~tes were appropriate and expressly deny any wrongdoing or liability with respect to those claims. Defendants have filed administrative appeals from HeFA's imposition of civil money penalties and the underlying findings of alleged deficiencies.
GENERAL PROVISIONS
5. In entering into this Consent Order and Judgment, defendants do not admit to any violation of law and the parties agree that this Order may not be used as evidence of liabi~.i ty in any other proceeding.
6. The parties agree that the provisions of this Order
."
are a lawful, fair and appropriate resolution of this case. 7. This Order is legally binding and judicially
enforceable by the parties and it shall be applicable to and binding upon all of the parties, their officers, agents, employees, assigns, and successors.
PAYMENT
8. The defendants agree to pay the sum of Five Hundred Thousand Dollars ($500,000) to the United States in settlement of this False Claims Act action and HCrA's civil money penalties. Payment of this amount to the United States Attorney's Office, 615 Chestnut Street, Suite 1250, Philadelphia, Pa. 19106, Attn.: David R. Hoffman, is to be made as follows:
3

(a) Upon entry of this Consent Order, the defendants shall remit the amount of:-Fifty Thousand Dollars ($50,000) by electronic funds transfer pursuant to directions of the United States Attorney's Office:
(b) Defendants shall remit, on a monthly basis, the amount of .$7,500 by certified check or electronic funds transfer for a period of five (5) years from the entry of this Consent Order, commencing on February 1, 1998.
(c) Defendants agree to provide to the United States a first-priority mortgage lien ("lien") on unencumbered property in an amount equal to the debt owed to the United States pursuant to this Consent Order. Defendants certify that the appraised value of the property shall be sufficient to satisfy the full amount of the debt owed ($450,000.00) to the United States. The amount of the lien shall be reduced by defendants' payment of scheduled installments as set forth in this Consent Order. Defendants shall provide, within 45 days from the date of entry of this Consent Order, an independent appraisal of the property and the appropriate documentation creating the lien.
DEFENDANTS' POLICIES AND PROCEDURES
9. Defendants agree to comply, and to cause all of their subsidiaries, officers, agents, employees, contractors, and/or subcontractors to comply with the Policies and Procedures attached hereto and incorporated herein as Exhibit A. Defendants
4

will provide the United States with notice and a reasonable period of time to review and approve additional policies and procedures pertaining to resident care as they are created, modified or discontinued.
NU'l'RITION AND WOUND CARE STANDARDS
10. Defendants agree to provide wound care (decubitus ulcer) treatment that meets or exceeds the Agency for Health Care Policy and Research Guidelines, attached hereto and incorporated herein as Exhibit B. Additionally, defendants agree to provide nutrition for those with wounds as set forth in Exhibit C, attached hereto and incorporated herein.
11. Defendants agree that Registered Dieticians will accurately calculate all residents' ideal body weight, compare current body weight to the residents' usual body weight in order to determine an appropriate healthy weight range for each resident on a regular and consistent basis and will clearly document such findings in the residents' charts.
12. Defendants agree to identify and provide timely clinical responses to all "nutritionally at risk" and "nutritionally compromised" residents at the earliest possible time. Nutritionally at risk and nutritionally compromised residents are defined in Exhibit A.
13. Defendants agree to obtain serum albumin levels for all residents at the time of "admission for screening purposes,
5

and as warranted thereafter to measure protein levels and will perform prealbumins in accordance with Exhibits A and C.
COMPLIANCE WITH FEDERAL LAW AND ATTACHED PROTOCOLS
14. In the operation and management of any of defendants' long-term care facilities and in providing services to the defendants' residents, the defendants shall comply fully with the particular provisions of the .Nursing Home Reform Act and other relevant prOVisions as embodied in Title XVIII of the Social Security Act, 42U.S.C. §§ 1395 et ~, and Title XIX of
the Social Security Act, 42 U.S.C. §§ 1396 !! ~, all
regulations and guidelines promulgated pursuant to these statutes and the American with Disabilities Act of 1990, 42 U.S.C. §§ 12101 et ~ See attached Exhibit 0, 42 C.F.R. Part 483, Subparts B, C, 0, and E, § 483.1 through § 483.206. The parties agree that the language in 42 C.F.R. § 483.1 through § 483.206 is incorporated by reference into this consent Order and that the provisions of this Consent Order are to be construed consistent therewith. Defendants shall also comply fully with the particular prOVisions of the defendants' protocols attached to this Order· and incorporated by reference herein. Defendants agree that their obligation to comply fully with the language of the attached protocols' does not limit their obligation to comply fully with federal law or with the provisions of this Order.
15. Defendants' submission of plans of correction and/or certification by the Health Care Financing Administration
6

does not in and of itself constitute compliance with this Consent Order nor does a cited deficiency by state or federal surveyors conclusively establish non-compliance with this Consent Order.
16. If the defendants seek to add a policy, procedure, or protocol which addresses resident care issues to this Consent Order or to modify a policy, procedure or protocol which has been attached to and incorporated into this Consent Order, the defendants shall first submit any proposed new or modified policy, procedure, or protocol to the United States and the Monitor as defined in paragraph 52 for review.
17. The United States or the Monitor may provide the defendants with comments or recommendations regarding the proposed new or modified protocol within 30 days of receipt of the proposed modification.
18. If the United States or the Monitor do not submit any comments or recommendations, the defendants shall submit the new or modified policy, procedure, or protocol to the Court as an agreed-upon exhibit.
19. In the event that the United States or the Monitor submits an~ comment~ or recommendations, the defendants shall consider th& comments and recommendations. If the defendants decline to adopt the recommendations or comments of the United States or the Monitor, they shall so notify, in writing, the United States and the Monitor, and the parties and the Monitor shall confer within 30 days.
7

20. If the parties reach agreement to add or modify a protocol, the"parties shall submit the new or modified policy, procedure or protocol as an agreed-upon exhibit. If the parties do not reach agreement, defendan~s may seek addition or modification of the policy, procedure or protocol with the Court and the United States may present its objections.
21. A new or modified policy, procedure, or protocol may be implemented immediately, if necessary due to emergency conditions or to comply with a change in the law, and then submitted to the Court.
RESiDENT SAlITX
22. Defendants shall provide a safe and functional
"
environment for the residents. Defendants shall ensure that all residents are free from mistreatment, verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, neglect, and misappropriation of property.
23. Defendants shall adequately supervise, monitor and safeguard the residents, especially those with histories of exhibiting behaviors that cause injury to themselves or others. Residents"shall be protected from being victimized by other aggressiver.residents.
24. Defendants shall promptly notify the United states and the Monitor of any resident death resulting from injuries, suicide, malnutrition, dehydration, diabetes or complications thereof, any incident of staff abuse or neglect (as defined in
8

the applicable federal guidelines) of a resident,. transfer and admission to a hospital as a result of injury or accident and any other incident involving a resident that prompts a full internal investigation, specifying for each death or incident, the full name and social security number of the resident, the date of death or incident, and, to the extent that such information is available to defendants, a brief description of the events surrounding the death or incident.
BASIC CARE
25. Defendants shall ensure that staff members provide residents with appropriate basic care services that meet the residents' individual needs. Among other things, defendants shall ensure that all residents are positioned properly, receive proper oral care and are bathed as scheduled, in appropriate water temperatures and with sufficient frequency. To that end, defendants shall ensure that the water temperature is constantly monitored and tested to ensure that no resident suffers any injury as a result of improper (i.e., within legal requirements for hot water and reasonable temperature for cold) water temperatures. A report of all tests pertaining to water temperature shal~ be provided to, reviewed and retained by the Administrator of each facility. In the case of Chester Care Center, all tests on water temperatures shall be immediately provided to the Monitor for review. Defendants shall care for
9

the residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life.
COKPRIHINSM ASSESSMENT AND CARE PLAN 26. Defendants shall ensure that there is a timely, complete, and accurate minimum data set (MDS) and a current, complete and accurate interdisciplinary care plan in each resident's chart. Defendants shall conduct, at the time of each resident's admission and periodically thereafter (at least annually and promptly after a significant change in the resident's physical or mental condition), a comprehensive, accurate, standardized assessment of each resident's functional capacity with input by all relevant disciplines. 27. Defendants shall ensure that within seven (7) days after the completion of the comprehensive assessment, the defendants' interdisciplinary team develops a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care plan shall describe the services that are to be furnishe~to attain or maintain the resident's highest practicabltphysical, mental, and psychosocial well-being and must meet professional standards of quality. Defendants shall ensure that each resident's comprehensive care plan is implemented in a timely manner by appropriate and adequately trained staff. Defendants shall examine each resident no less
10

than once every 3 months and as appropriate, revise the resident's assessment to assure the continued accuracy of the assessment.
ACTIVITIES
28. Defendants shall provide residents with sufficient, meaningful activities both during the week and on the weekends to ensure that the residents attain or ma~ntain the highest practicable physical, mental, and psychosocial well-being. Defendants shall provide for an ongoing structured program of activities designed to meet the individual interests and physical, mental, and psychosocial well-being of each resident, and defendants shall provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Defendants shall ensure that unit-based activities are provided for those residents unable to attend activities elsewhere. Defendants shall evaluate the activities programs for effectiveness and modify their programs as warranted.
CHEMICAL AND PHYSICAL RESTRAINTS
29. Defendants shall ensure that physical and chemical restraints are used only pursuant to accepted professional' standards and that they are never used as punishment or for the convenience of staff. Defendants shall assess, document, advocate and ensure that any restraints used, whether chemical or
11

physical, are the least restrictive restraints appropriate for the resident and the situation. An interdisciplinary team will review and evaluate the need for restraints in all cases. Defendants recognize that they have an obligation to seek the least restrictive restraint for residents.
30. Defendants shall ensure that appropriate physicians' orders are obtained and followed before physical restraints are utilized and shall at all times seek the implementation of the least restrictive alternative for their residents.
31. Defendants shall ensure that residents are released from any physical restraints at least every two hours for at least 10 minutes under supervision by staff and are assessed at such time as to whether they need to remain in restraints. All residents who are restrained shall be appropriately repositioned and provided with adequate supervision, hydration, and circulation while in restraints.
32: Defendants shall only use psychotropic medication in accordance with accepted professional standards and where there is am-appropriate psychiatric or neuropsychiatric diagnosis. Defendants must evaluate the availability of behavior management prior to the use of medication. Defendants must not use psychotropic medication as punishment, in lieu of a training program, for behavior control, in lieu of a psychiatric or neuropsychiatric diagnosiS, or for the convenience of staff.
12

33. Absent emergency circumstances, defendants shall ensure that pr,ior to using psychotropic medication, other less restric" tive techniques have been systematically tried and have been demonstrated to be ineffective. Prior to using psychotropic medication, defendants will also ensure that:
(a) a psychiatrist reviews the current medication regimen of each individual to determine whether the type and dosage of the medication is appropriate and still necessary, and recommends any changes in the medication regimen;
(b) the psychiatrist consults with the resident's pri~ary care physician, nurse, and other appropriate members of the resident's interdisciplinary team, to determine whether the
"
harmful effects of the resident's mental illness clearly outweigh the possible harmful side effects of the psychotropic medication and whether reasonable alternate treatment strategies are likely to be less effective or potentially more dangerous than the medication.
PSYCHIA'l'RIC AND RELATED SERVICES
34. Defendants agree to develop and implement a professionally appropriate system to: (a) regularly monitor the progress ot the defendants' residents with mental illness to ensure that staff members are continually taking whatever steps are necessary and appropriate to address the individual's mental health needs; (b) provide ongoing monitoring of the efficacy of
13

treatment and make revisions in the treatment plan when warranted; (c) implement a protocol whereby a psychiatrist promptly sees any resident with a diagnosis of mental illness who has recently exhibited violent or threatening behaviors.
35. Defendants shall develop and implement an adequate and appropriate system, utilizing an interdisciplinary approach and based on generally accepted professional standards, for detecting, reporting, and responding to any drug-induced side effects of psychotropic medication; take special care to adequately and appropriately monitor involuntary movement side effects; adequately train and in-service appropriate nursing and direct care staff in how to properly monitor and document medication side effects.
MEDICAL CARE
36. Defendants shall ensure that residents receive adequate preventive, chronic, routine, acute, follow-up, and emergency medical care in accordance with generally accepted standards of care. Defendants shall provide the necessary health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. To that end, defendants shall ensure that a physician is available 7 days a week to address changes in residents' medical conditions which warrant physician intervention.
14

37. Defendants shall take all reasonable steps, including intervention by their medical directors or revocation of physician privileges at defendants' facilities, to ensure that residents receive the care under paragraph 36, including that:
a. Physicians promptly obtain and review all laboratory and test results, document the responses in the residents' charts and take appropriate actions to address any abnormal results;
b. Physicians complete monthly notes in the residents' charts on a timely basis;
c. Physicians do not rely inappropriately on telephone orders in treating residents;
d. Physicians address promptly residents' significant or undesirable weight loss and personally provide continual follow-up until the situation is adequately addressed;
e. Health care of all diabetic residents comports with generally accepted medical practice;
f. All individuals with seizure disorders at defendants' facilities are provided with adequate and appropriate seizure management in accordance with accepted professional standards of care and with adequate and appropriate seizure documentation and with adequate and appropriate diagnostic techniques;
g. Residents currently receiving anticonvulsant medication, receive the type of medication(s) that is (are)
lS

appropriate and effective for the type of seizure and represents the fewest number of medications appropriate for effective seizure management;
h. There are a sufficient number of neurology consult hours to meet the needs of the residents and to provide each resident with a seizure disorder with a neurology review every six (6) months;
i. As indicated by accepted professional standards of care, in the event'of a medical emergency involving a resident, including status epilepticus, facility staff will immediately call an ambulance, and will initiate appropriate emergency interventions while awaiting arrival of the ambulance prior to transport of the resident to the closest tertiary care facility;
j. Physicians conduct comprehensive health care evaluations of all residents;
k. Physicians determine what specialized medical services are required for the residents and ensure that such services are timely provided whenever necessary to evaluate or treat the resident's medical problems;
1. An integrated medical plan of care for each resident exists;
m. Each resident's medical status and progress in response to the resident's medical plan of care is regularly
16

and adequately reviewed and all changes appropriately documented;
n. Each resident's drug regimen is free from unnecessary drugs, i.e., any drug used in excessive dose, for excessive duration, without adequate monitoring, without adequate indications for its use, in the presence of adverse consequences which indicate the dose should be reduced or discontinued, or any combinations of the reasons set forth herein;
o. Adequate and appropriate interdisciplinary communication among relevant professionals, especially between and among physicians and nurses;
p. Physicians communicate with the pharmacist pertaining to therapeutic responses by residents to prescribed medications.
NURSING CARE
38. Defendants shall ensure that residents receive adequate and·· appropriate nUrsing care, and that nurses perform their responsibilities in keeping with accepted professional standard~ot care by adequately identifying health care problems, notifyin~phY5icians of health care problems, monitoring and intervenin~ to ameliorate such problems, and keeping appropriate records of residents' health care status. Defendants shall provide the necessary nursing care and services to attain or
17

maintain the residents' hiqhest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive
,
assessment and plan of care. Defendants shall take, at a ,minimum, the following measures: a. Conduct adequate, comprehensive nursing assessments, with quarterly updates, of the nursing care needs of the residents; b. Develop nursinq protocols and develop and implement adequate and appropriate comprehensive interdisciplinary care plans to address each resident's health care neeqs; c. Routinely perform ongoing monitoring of serious medical conditions, including such basic procedures as taking vital signs and measuring weights; d. Implement a system for recording important information about a resident's status to monitor changes; e. Regularly monitor the progress of residents to ensure that staff members are continually taking whatever nursing steps are necessary for the health care of the individual; f. Communicate essential information to physicians; q. Follow physicians' orders or document fully why a physician's order was not expressly followed; h. Administer medications in a timely manner consistent with accepted nursing practice and provide the necessary supervision and training to minimize medication errors and
18

if a medication error occurs, promptly investigate the error, properly document it and take appropriate corrective action;
i. Ensure that residents are provided with adequate skin care, nutrition, turning and positioning to decrease the likelihood of skin breakdown; perform skin care assessments and ongoing treatments and therapy to prevent skin breakdown; comply fully with the particular provisions of Exhibit A and the Clinical Practice Guidelines Number 15 entitled "Treatment of Pressure Ulcers," promulgated by the Agency for Health Care Policy Research, attached as Exhibit B;
j. Follow standard infection control procedures, maintain aseptic technique and conditions at treatment sites; require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice: establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection;
k. Ensure that residents' nutritional intake is adequate, that weights are routinely and accurately recorded, and that residents receive appropriate diets, adequate amounts of food, and sufficient quantities of fresh water to ensure proper hydration; ensure that residents are
19

provided with proper mealtime assistance and supervision and with appropriate eating assistive devices and adaptive equipment where necessary; ensure that residents with significant or undesirable weight gains or losses are promptly seen by nursing and dietary staff and provided with continual follow-up until the situation is adequately addressed; ensure that each resident receives food prepared by methods that conserve nutritive value, flavor, and appearance, food that is palatable, attractive, and at the proper temperature, prepared in a form designed to meet individual needs; offer substitutes of similar nutritive value to residents who refuse food served;
1. Ensure nurses provide adequate and acceptable health care to residents with diabetes, including properly evaluating blood sugars and providing appropriate treatment when necessary; ensure nurses promptly notify a supervising registered nurse and/or physician when necessary to meet the residents' needs; ensure nurses follow physicians' express orders with respect to the care and treatment of diabetic residents; and comply with the protocols attached as Exhibit E ancr.incorporated by reference herein;
m. utilize an interdisciplinary approach to properly assess and appropriately treat residents with swallowing problems and residents who are unable to eat orally in accordance with accepted professional procedures. To this
20

end, defendants agree to: (1) provide adequate care for those residents at risk of aspiration, take any appropriate steps to ameliorate the individual's aspiration risk, and develop and implement an individualized feeding and positioning plan for each resident identified as at risk of aspiration; and (2) train staff in how to properly implement the feeding and positioning plans, and shall deve~op and implement a system to regularly monitor the progress of the residents who are at risk of aspirating to ensure that the staff is continually taking whatever assessment, diagnostic, supervision and treatment steps are necessary to ameliorate the resident's risk;
n. Procure sufficient nursing staff to ensure adequate continuity of resident care so that the facility is not excessively reliant on temporary contract nurses; •employ sufficient nursing staff to provide nursing and related services on a 24-hour basis to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assesamenta·andindividual plans of care.
'rBIJtAPX SIBY+ClS 40. Defendants shall provide each resident in need of such services with adequate and appropriate physical therapy and occupational therapy services.
21

HOST INTEGRATED SETTING
41. Defendants shall ensure that appropriate professionals evaluate each resident to determine whether the resident is being served in the most integrated setting appropriate to the resident's needs. An initial evaluation shall occur within fourteen days of admission as part of a comprehensive assessment of each resident. Each resident shall be re-evaluated at least every three months or sooner if there is a significant change in the resident's physical or mental condition.
42. Defendants shall implement professional decisions
"
that a resident can be served in a more integrated setting by transferring the resident to the alternative setting.
43. Defendants shall ensure that before any resident is transferred to a more integrated setting, the setting is capable of meeting the resident's needs, and once transferred, the needs of the resident are being met.

gCOBJ:)QIPnJQ

",_

of

44. Defendants shall ensure that they maintain medical

records for each resident that comports with accepted

professiona%'standarda and includes current information with

respect to thar individual 's care, medical treatment, and

activitie8r" Defendants shall maintain clinical records on each

resident in accordance with accepted professional standards and

practices that are complete, accurately documented, readily

accessible, and systematically organized. Defendants recognize

22

that if clinical responses are not clearly documented, there is a rebuttable pr~sumption in this proceeding that they did not, in fact, occur.
45. Defendants shall ensure that professional staff, including physicians, psychiatrists, therapists, and nurses, as well as direct care staff, make timely and appropriate notes in the residents' records detailing the residents' progress, status, condition, and detailing the steps needed to fully meet the residents' needs. Defendants shall ensure that all professional staff utilize such records in making care, medical treatment and training decisions.
OJ1AL:rTX ASSJl'RAN'CI 46. Defendants shall maintain a quality assessment and assurance committee that develops and implements appropriate plans of action to correct identified quality deficiencies.
STAllmA
47. Defendants shall ensure that a sufficient number of professional and non-professional staff, especially nurses, are employed to fully meet the needs of the residents.
STAll TBAnmJQ
48. Defendants shall provide a training program to ensure that all professional and direct care staff who provide services to residents are adequately trained to implement the requirements of this consent Order and are thereafter provided
23

with in-service training on a regular basis. Defendants shall provide a training progra~ for all personnel, including physicians, nurses and dieticians regarding, at a minimum: nutrition; wound care and infection control; abuse and neglect; appropriate drug therapies for the elderly; diabetes; behavior modification; renal disease; mental health needs of residents; and a coordinated interdisciplinary approach to providing care to residents. Defendants shall ensure that all nurse aides are appropriately trained and demonstrate competence in the performance of their duties. Defendants also agree to report all training sessions to the U.S. Attorney's Office and the Monitor.
49. Defendants shall ensure that their medical staff regularly attends continuing medical education programs that address geriatrics, including but not limited to, medical therapies utilized in wound care, nutrition and diabetic care for long-term care residents.
RIDI'1'IOJI or TlCBHXc:AL ASSIST»jCI
50. If anll to the extent that the defendants require additional outside technical assistance to comply with the provisions of this Order, they shall obtain such technical assistanc~ and provide to the United States and the Monitor a list of tha professionals providing the assistance and a list of topics addressed by the professionals.
TlMPOBARY IJIlWjIKINT 51. The defendants have hired and installed Peggy McDonough, M.S.N., as temporary manager at Chester Care Center.
24

The parties agree that defendants' temporary manager shall have all of the regulatory authority set forth in 42 C.F.R. §48S.415(a), including but not limited to, the independent authority to hire, terminate or reassign, staff, obligate facility funds, alter facility procedures, and manage the facility to correct deficiencies identified in Chester Care Center. The defendants shall employ the temporary manager until Chester Care Center is in substantial compliance with all Medicare requirements, and for a period of at least six (6) months thereafter. The temporary manager may be removed from her position for cause with the assent of the United States. The temporary manager shall coordinate her activities with the Monitor to ensure that appropriate decisions'are made pertaining to staffing and quality of care issues for those residents residing at Chester Care Center.
MONlTOB 52. A Monitor shall be appointed by January 23, 1998, who shall have full authority to oversee the defendants' compliance with the provisions of this Consent Order. The Monitor shall assess independently defendants' compliance with this Order, with the attached protocols, and with 42 C.F.R. § 483.1 througkt.. I: 483',206 and- guidelines as incorporated into this Order. The Monito: shall not:" be bound in his or her conclusions, in whole or in part, on the basis of any certification by the Health Care Financing Admdnistration. In addition, the Monitor shall advise management and staff as to possible procedures that, in
25

the Monitor's view, may be implemented to facilit'ate compliance with this Order. Defendants are not bound by the Monitor's conclusions and may contest the same.
53. Defendants agree to allow the Monitor access to Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center at any time and without prior notice, to assess compliance with this Consent Order. The Monitor shall visit these long-term care facilities at least monthly until this Order is terminated and shall have immediate access to all nursing home residents and their records. The Monitor shall also have access to relevant documents and records in the possession of defendants and to defendants' quality assurance reviews for purposes of ensuring coordination of responses to identified problems. Upon request, the Monitor will be promptly provided with access to and/or copies of incident reports, investigations, resident records, and any other records necessary to enable the Monitor to fulfill his or her duties under this Order. The Monitor shall attempt to coordinate his· or her activities with relevant personnel in order to minimize disruption in the day to day operations of the facility. At all times, tha Monitor'shall respect the privacy and dignity of all resident... ,,,..
54. Th~Monitor shall create a report documenting any adverse findings relating to compliance with this Order and shall present the report within ten calendar days of the site visit to the defendants, the United States Attorney's Office, the U.S.
26

Department of Health and Human Services, Office of the Inspector General, and the Health Care Financing Administration. The Monitor shall submit to the parties a quarterly status report regarding the defendants' compliance with the terms of this Order. The Monitor may confer and correspond with the parties on an ~ parte basis.
55. The parties agree that Sahar M~ammad, R.N., shall 'serve as the Monitor and that she serves at the behest of the United States and may be removed from the Monitor position solely at the discretion of the United States. In the event the Monitor is replaced, the United States shall submit the name(s) and curricula vitae of the new proposed Monitor to the Court and the defendants shall have the right to present to the Court their position as to the new proposed Monitor.
56. The Monitor shall submit within thirty days of his/her designation an initial budget for monitoring activities. Subject to ,the budget provided pursuant to this Consent Order, the Monitor may retain independent consultants, as needed, to meet his or Her obligations'under this Order. Defendants shall bear all reasonable costs of the Monitor consistent with the budget ~.th.... parties agree that the total annual budget for the monitoriDEI: ~aJD shall not exceed the amount of $150,000, except in the- event that unforeseen circumstances arise. Defendants agree to fund the Monitor at the, same annual rate until this Order is terminated.
27

ACCESS TO PEPENDANTS' FACILITIES
.' 57. The Monitor, the United States and its agents
shall have the right to request, inspect, review and copy facility records, resident charts and other documents, including all financial data pertaining to Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center, conduct interviews with residents and staff outside the presence of supervisory staff or counsel, and observe activities normally conducted at the various facilities to assess compliance with this Order. The Monitor, the United States and its agents agree to respect the privacy and dignity of the residents.
COBPQBUI CQMPLIAHCI PRCXiR!W 58. The defendants agree to adopt a Corporate Compliance Program tha.t sets forth the structure for reporting and addressing all components relevant to the provision of adequate care, e.g., medical, nursing, nutrition, wound care, dietary, housekeeping, laundry, infection, plant operations and facility management services. This Program shall be submitted for approval by the Office of Counsel to the Inspector General, Civil Recoveries. Branch-Compliance Unit, Department of Health and Human Service. by March 31, 1998. The Office of Counsel to the Inspecto: General shall have sixty (60) days from receipt of the defendants' Program within which to review and either accept or reject the Program. If, after reasonable attempts have been made to obtain an acceptable Compliance Program, and this Program is
29

not approved by May 31, 1998, the United States may treat this failure as a material breach as defined in paragraph 65 of this Order and as grounds for exclusion from the Medicare Program in accordance with the procedures set forth in paragraph 65.
HClA TERMINATION PROCESS
59. This consent Order will not forestall the termination action scheduled for January 14, 1998 if Chester Care Center does not come into substantial compliance with Medicare requirements. In the event Chester Care Center is terminated from the Medicare Program, however, and subsequently comes into compliance with Medicare requirements, this Consent Order shall serve as the -reasonable assurance- necessary for readmission to
,
the Medicare Program. This Consent Order does not preclude any future civil money penalty or termination actions based on events occurring after the entry of the Consent Order.
TBRMXNATION or CONSmr ORDA
60. The Court shall retain jurisdiction of this action for all purposes under this Consent Order until defendants shall have fully and faithfully implemented all provisions of the Order and until this action is dismissed.
61. On or after the date on which the defendants shall have fully aDd faithfully implemented all provisions of this Consent Order, th~detendants may move that the case be closed on the grounds that defendants have fully and faithfully implemented and maintained all provisions of this Order. The parties
29

· contemplate that the monitoring program will last for a period of at least two (2) years from the date of the entry of this Order. 62. Subject to defendants' continuing payment obligations under this Consent Order, dismissal shall be granted if the defendants are in material compliance with this Consent Order for a reasonable period of time and unless, within 60 days after receipt of the defendants' motion, the United States objects to the motion. If the United States makes such an objection, the Court shall hold a hearing on the motion and the burden shall be on the defendants to demonstrate that they.have fully and faithfully implemented all provisions of this Consent Order. 63. In the event of any filing ofa motion to terminate this Order, nothing in this Order precludes the parties from conducting discovery pursuant to the Federal Rules of Civil Procedure. 64. The parties reserve the right to withdraw consent to this Consent Order in the event that this Order is not approved by the Court in its entirety.
IIlORCIMIN'l' or COHSIB'1' ORDBB
6!i',;';', 111 th. event that defendants and/or their agents, employee-"'.:contractora and subcontractors fail to materially comply in g~·faith with the terms of this Consent Order, that is, fail to meet any obligation under this Consent Order that has a significant impact on the quality of care rendered to· any resident or residents, or should any of defendants'
30

representations be materially false, the United States may, at its sole disc~etion, exercise one or more of the following rights':
(a) seek contempt of court based on the failure of defendants and/or their agents, employees, contractors and subcontractors to materially comply with this Consent Order. The parties agree that, after a finding of civil contempt, a penalty of ten thousand dollars ($10,000) per day may be assessed, beginning upon the finding of contempt and lasting until all defaults are cured. After curing. all defaults, the defendants may petition the Court to lift its contempt order and to withdraw the imposition of any penalties;
(b) exercise any other right granted by ,law, including exclusion of defendants or any of their officers, directors, agents and employees from the Medicare Program, Medicaid Program and all other state and federal health programs. In the event the United States decides to seek exclusion as one of its enforcement remedies based upon a material breach of the Consent Order or Corporate Compliance Program, the HHS-OIG will notify defendants of the alleged breach, in writing, specifying the circumstances of the alleged breach. A material breach under this subsection is a failure by any of the defendants to meet an obligation under the Consent Order or Corporate Compliance Program that has a significant impact on the quality of care rendered to any resident or residents of defendants' facilities or a significant impact on the Medicare or Medicaid Programs. Defendants shall
31

have 15 calendar days in which to respond to this notification and 30 days from the noti~ication to demonstrate to the HHS-OIG that they are not in material breach or that the breach has been cured. If, in response, HHS-OIG determines that defendants are in default of this Order or the Compliance Program, it may institute an action to exclude defendants and/or any of their individual officers, directors, employees, agents from ,participation in the Medicare Program, Medicaid Pr~gram and state and federal health programs until such time as the breach is cured, for a specified length of time, or permanently. Notwithstanding any provisions of Title 42 of the United States Code or Chapter 42 of the C.F.R., the sole issues in a proceeding for exclusion based on breach of this Order will be: (a) whether defendants materially breached one or more of their obligations as specified in the notice of breach; (b) whether it was reasonable for such breach to have been cured within 30 calendar days; (c) whether defendants had taken significant action to cure the breach or had done so with reasonable diligence; and Cd) whether such breach was' continuing on the date HHS-OIG instituted an action to exclude defendants.
(c) exercis&any right recognizable at common law or equity
. including:. in.iunctive relief.
lILIAS'S 66. In consideration for such repose and on the terms and conditions contained herein, and upon payment in full of the amount due the United States as set forth in this Consent Order,
32

and as expressly provided below, the United States fully and finally releaaes and forever discharges the defendants, their officers, employees, servants and agents from any and all civil and administrative monetary claims, demands, damages, liabilities, losses and causes of action, including penalties and costs of investigation under the False Claims Act, 3l U.S.C. ii 3729 ~ ~, the Civil Monetary Penalties Law, 42 U.S.C. i l320a-7a, the Medicare and Medicaid Patient and Program Protection Act, 42 U.S.C. il320a-7{b), or the Program Fraud Civil Remedies Act, 3l U.S.C. ii 380l-38l2, or the common law th~ories of payment by mistake, unjust enrichment, breach of contract, and fraud, for the billing for alleged inadequate care rendered to residents of Chester Care Center, Bishop Nur~ing Home and Manchester Nursing & Convalescent Center in violation of regulations governing standards of care applicable to long-term care facilities from June 1995 through the date of the entry of this Consent Order.
67. The parties agree that the release given in the preceding paragraph specifically excludes the following:
a. Any civil or administrative disputes, adjustments or claims relating to matters other than the alleged violation of standarda o&,.c:are rendered to residents of Chester Care Center, Bishop Nursing- Home and Manchester House Nursing Home & Convalescent Center from June 1995 through the date of entry of this Consent Order.
33

b. Any disputes or claims arising under the Internal Revenue Code.
c. Any disputes or claims arising under any express or implied warranties relating to products or services.
d. Any disputes or claims arising under the criminal laws of the United States.
e. Any enforcement proceedings based upon the defendants' violations of this Agreement.
f. Any HHS-OIG administrative exclusion action pursuant to 42 U.S.C. §1320a-7a, 42 U.S.C. §1320a-7(b), or 42 U.S.C. §1320a-7(d), based on events occurring after the date of entry of this Consent Order.
g. Any intentional fraudulent conduct performed by the defendants and/or their agents or employees.
68. Defendants agree that all costs (as defined in the Federal Acquisition Regulation (MFARM) 5 31.205-47 and in Titles XVIII and XIX of the Social Security Act, 42 U.S.C. 55 1395 At. ~ and 55 1396 At.~, and the regulations promulgated thereunder) incurred by or on behalf of defendants, in connection with: (a) the government's investigations, and defendants' investigatiomrand defense of this False Claims Act proceeding, (b) the negotiatioD~f this Order, (c) any corrective action
for the released acts during the relevant period, and (d) the payments made to the United States pursuant to this Order, shall be unallowable costs for government contract accounting and for Medicare, Medicaid, CHAMPUS, VA and
34

FEHBP reimbursement purposes. These amounts shall be separately estimated and accounted for by defendants, and defendants will not charge such costs directly or indirectly to any contracts with the United States or any State Medicaid program, or to any cost report, cost statement, or informa·tion statement submitted by defendants, CHAMPUS, VA or FEHBP programs. Defendants agree further that within 60 days they will identify to applicable Medicare and CHAMPUS fiscal intermediaries, carriers and/or contractors, and Medicaid fiscal agents any unallowable costs (as defined in this paragraph) included in payments sought in any cost reports, cost statements or information reports already submitted by defendants or any of its subsidiaries and will request that such cost reports, cost statements or information reports, even if already settled, be adjusted to account for the effect of the inclusion of the unallowable costs. Any payments due after the adjustments have been made shall be paid to the United States at the direction of the Department of Justice, and/or. the affected agencies. The United States reserves its rights to disagree with any calculations submitted by defendants or any of its subsidiaries on the effect of inclusion of unallowab~ coat.. Ca.. defined in this paragraph) on defendants I ,
·i.............-;~·· . .
or any o~it"8Ub.idiaries· cost reports, cost statements or "r:..f!'I,...~~" .~
informatioD~rePort.~· Nothing in this Agreement shall constitute a waiver of the rights of HHS, or any Medicare or CHAMPUS fiscal intermediary or contractor, or any Medicaid fiscal agent, to
35

examine or re-examine the unallowable costs described in this paragraph.
69. In consideration for such repose and on the terms and conditions contained herein, defendants fully and finally release, dismiss, and forever discharge the United States, its agencies, employees, servants, and agents, from any and all claims, causes of action, liabilities, losses, appeals of remedies imposed by HCFA, and damages, including attorney's fees, costs and expenses which defendants have asserted or could have asserted against the United States, its agencies, employees, servants, and agents, related to the billing for alleged inadequate care rendered to residents of Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center in violation of regulations governing standards of care applicable to long-term care facilities from June 1995 through the date of entry of this Consent Order. Defendants agree that within five (5) days of the entry of this Consent Order, they will notify the Administrative Law Judges presiding over all administrative appeals filed by defendants pertaining to remedies imposed by HCFA, excluding the appeal of HCFA's termination action dated.December"22, 1997, that the appeals are withdrawn with prejudice and that all requests for hearings are also withdrawnwitb prejud1~e.
70. The parties agree that the release set forth in paragraph 69 specifically excludes any dispute or appeal that defendants may assert in connection with any claim for
36

reimbursement under the Medicare or Medicaid Programs for

services other than those provided to the individuals which are

the basis for this proceeding.

COSTS

71. All parties shall bear their own costs, including

attorney fees.

RETALIATION

72. Defendants and its agents, employees, contractors,

and/or subcontractors agree not to take any retaliatory action

against any individual or individuals who cooperated with this investigation and/or who cooperates with the United States or the

Monitor throughout the pendency of this Consent Order.

SIGNATURES

73. All signatories to this Consent Order hereby

warrant that they have the authority to and have entered into

this Consent Order knowinqly, voluntarily and of their own free

will and without duress of any kind. This Consent Order may be

executed in two or.more counterparts, each of which shall be

deemed an oriqinal but all of which toqether shall constitute one

and

the

sam.. instrument.

. £~ :." :~:.
.:s" , ~ ~L:?:.~1. ~ ~-~

..;'." p'-;''£~.--:'': ": ' . .

. ' . .~.

.~~_.:.......r..'. "".

. .

.;;: ;:,.' ,....-:

37

We, the undersigned, consent to the entry of the above Consent Order~ We represent to the Court that this Consent Order contains a complete description of the agreement between the parties. All material representations, understandings and promises of the parties are contained in this Order. Any modifications must be set forth in writing and signed by all parties. The defendants represent that this Consent Order is entered into with knowledge of the events described herein, and that it is entered into knowingly and voluntarily, without any degree of duress or compulsion whatsoever.

UNITED STATES OF AMERICA:

DEFENDANTS:

ICHAEL R. STILES ITED STATES ATTORNEY

WALTER M. STRINE, JR. AUTHORIZED TO SIGN FOR:

CHESTER CARE CENTER

BISHOP NURSING HOME

MANCHESTER HOUSE NURSING

, CONVALESCENT CENTER

-'j(,ffi~9~ffiiift~~...;;::==--...:rHE BISHOP NURSING HOME, INC.

n

COMMONWEALTH REAL ESTATE INVESTORS

LEWIS MoRJiltiii;.;,ti;,
ASSISTAN7lmnc'1'OR' GENERAL
OFFICE or COONSUi. TO. THE INSPECTOR GENERAL
DEPARTMENT' OK' HEALTB: AND HUMAN SERVICES

38

JAMES C. NEWMAN
CHIEF COUNSEL, REGION III ASSISTANT REGIONAL COUNSEL COUNSEL FOR HEALTH CARE FINANCING ADMINISTRATION
APPROVED AND SO ORDERED: J.
..... .,:'
39

ASSISTAn INSPECTOR G.tNEML

OFFlCZ OP CoaYSI~ TO THE lNSPECTOa GENERAL

o r %)EPAa'1'MZN'r

HJ:AL'l'H AND HtlIQll SERVICJ:S

.. ...... .. ~:.~ ~

. ~. .

, .

CHESn:~ CARE CE

BISHOP NURSING
MMCHtSTU SOUS
, CON'VlU,ESC!NT ~~..

TO BISHQP

DIG HOHI, INC.

CCIHKONW£At.tK

ES1'An; nm:STORS

41

U.S. Department of Justice
United States Attorney
Eastern District ofPennsylvania
615 Chestnut Street Suite 1250 Philadelphia, Pennsylvania 19106-4476 (215) 451-5200
January 13, 1998
PRE S S RELEASE
Michael R. Stiles, United States Attorney for the Eastern District of Pennsylvania, Michael Little, Regional Inspector General for Investigations, Department of Health and Human Services and Judith Berek, Acting Regional Administrator for the Philadelphia Regional Office, Health Care Financing Administration (HCFA), today announced the filing of a civil False Claims Act Complaint against three nursing homes located in Delaware County for the provision of inadequate care to their residents. A Consent Order was filed simultaneously with the Federal District Court in which the owner of the facilities agreed to pay the federal government $500,000 and to implement a comprehensive compliance program to settle claims resulting from an investigation into the quality of care provided to residents from June 1995 to the present.
In its Complaint against Chester Care Center, Bishop Nursing-Home, and Manchester House Nursing & Convalescent Center and their corporate owners, the government charged that the defendants did not render adequate care -to their residents and the Complaint specifically identifies 5 residents for whom the government was paying who were not adequately cared for by the defendants.
Specifically, the care rendered to 3 residents of Chester Care Center with diabetes was inadequate in terms of monitoring and responding to complications associated with diabetes, and the provision of nutrition and wound care.
Another individual, a resident of Chester Care Center, was scalded to death when a nurses' aide placed the resident, who was unable to speak, ihto 138 degree Fahrenheit water during a bath. The government's Complaint alleges that the defendants knew that there were problems with the water temperature and did not adequately address that issue.- The nurses' aide has been criminally charged by the state Attorney General's Office.

The final victim, a resident of Bishop Nursing Home, was allegedly improperly cared for in terms of his nutrition and wound care while the facility billed the Medicaid program for his care. The government alleged that the facility did not respond to this resident's weight loss in a timely fashion and as a result he developed pressure sores (decubitus ulcers) which were not properly treated.
U.S. Attorney Stiles stated that this False Claims Act case was the second of its kind in the country pertaining to quality of care in the nursing home environment and should once again serve notice to the nursing home industry that a failure to provide adequate care to some of the most frail and vulnerable ·members of society will not be tolerated. "Quality of care for those residing in nursing homes must be protected by all means possible,'/I Stiles noted.
In addition to the payment, the terms of the Consent Order apply to approximately 700 residents and require:
-State-of-the-art treatment protocols for residents with diabetes;
-Retention of a temporary manager for Chester Care Cent.er to manage the facility and ensure compliance with federal law and regulations;
-A full-time federal monitor for all three facilities for at least two years;
-Provision of wound care in accordance with the Agency for Health Care Policy and Research .(AHCPR) guidelines and enhanced nutrition protocols;
-Development of a' corporate compliance program that ensures appropriate responses to, among other items, weight loss, wound care and diabetic care;
-Training of staff on all issues contained in the Consent Order.
The development of the protocols for this case was done with invaluable assistance from the following individuals:
Stanley Schwartz, M.D., Bruce Kinosian, M.D., Ilene Warner, R.N.,C, CWCN, Barbara J. Maschak-Carey, R.N., M.S.N., Sue Bradley, R.N.,C
2

This case also included support from representatives of theJ

Pennsylvania Department of Health and Department of Public

II

Welfare.

The case was handled by Assistant United states Attorney David R. Hoffman.

I

3

 
 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

UNITED STATES OF AMERICA,

Plaintiff, v.

:CIVIL ACTION NO. 98- C;1/-/?7

CHESTER CARE CENTER BISHOP NURSING HOME MANCHESTER HOUSE NURSING & CONVALESCENT CENTER THE BISHOP NURSING HOME; INC. and COMMONWEALTH REAL ESTATE INVESTORS

Defendants.

COMPLAINT INTRODUCTION The United States, through the United States Attorney for the Eastern District of Pennsylvania, brings this civil action under the False Claims Act, 31 U.S.C. § 3729, et seq., and alleges that Chester Care Center, Bishop Nursing Home, Manchester House Nursing & Convalescent Center, The Bishop Nursing Home, Inc. and Commonwealth Real Estate Investors, schemed to bill and collect from the United States of America for services associated with the care rendered to the elderly residents of Chester Care Center and Bishop Nursing Home when, in fact, that care was not adequate. Congress, in the Omnibus Budget Reconciliation Act of 1987 ("OBRA '87"), enacted the Nursing Home Reform Act, 42 U.S.C.A.

§1396r et ~., (hereinafter "the Act") which took effect on
October 1, 1990. A nursing facility is defined in the Act as "an
institution •.. which--
(1) is primarily engaged in providing to residents--
(A) skilled nursing care and related services for residents who require medical or nursing care,
(B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or
(C) on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; .....
42 U.S.C.A. § 1396r(a).
The Act mandates that nursing facilities comply with federal
requirements relating to the provision of ~ervices. 42 U.S.C.A.
§ 1396r(b). Specifically, in terms of the quality of life for
residents of nursing facilities, the Act states that: "A nursing
facility must care for its residents in such a manner and in such
an environment as will promote maintenance or enhancement of the
quality of life of each resident." 42 U.S.C.A. § 1396r(b) (1) (A).
Additionally, the Act mandates that a nursing facility
"provide services and activities to attain or maintain the
highest practicable physical, mental and psychosocial well-being
of each resident in accordance with a written plan of care which-

(A) describes the medical, nursing, and psychosocial needs of the resident and how such needs will be met; ... "
42 U.S.C.A. § 1396r{b) (2) (A). A duty is placed on the nursing facility to fulfill the
residents' care plans by providing, or arranging for the provision of, inter alia, nursing and related services and medically-related social services that attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, pharmaceutical services and dietary servi.ces that assure that the meals meet the daily nutritional and special dietary needs of each resident. 42 U.S.C.A. § 1396r(4) (A) (i-iv) .
The Social Security Act mandates that skilled nursing facilities that participate in the Medicare Program and nursing facilities that participate in the Medical Assistance Program, also known as Medicaid, meet certain specific requirements in order to qualify for such participation. These requirements are set forth at 42 C.F.R. § 483.1 et seq. and "serve as the basis for survey activities for the purpose of determining whether a facility meets the requirements for participation in Medicare and Medicaid.... 42C .. F.R. § 493.1.
Federal regulations, when addressing quality of care concerns, mandate that "[e]ach resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and
3

psychosocial well-being, in accordance with the comprehensive assessment and plan of ca~e." 42 C.F.R. § 483.25. The regulations specifically address the area of nutrition:
(i) Nutrition. Based on a resident's comprehensive assessment, the facility must ensure that a resident--
(1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and
(2) Receives a therapeutic diet when there is a nutritional problem. 42 C.F.R. § 483.2S(i). Additionally, the Federal regulations specifically address those individuals who are tube-fed:
(g) Naso-gastric tubas. Based on the comprehensive assessment of a resident, the facility must ensure that--
(1) A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident's clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
(2) A resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-
4

pharyngeal ulcers and to restore, if possible, normal eating skills. 42 C.F.R. § 483.25(g). The federal regulations also provide that pressure sores be adequately treated as follows: (c) Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that--
(1) A resident who enters the facility without pressure sores do~s not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressures sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. 42 C.F.R. § 483.25(c). Defendants Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center are licensed longterm care (nursing) facilities under federal and state law and are certified to participate in the Medicare and Medical Assistance Programs. The Medicare Program is a health insurance program for individuals 65 years and older, certain disabled individuals under age 65 and people of any age who have permanent kidney failure. The Medicare statute is codified at 42 U.S.C.A. § 1395 (Title XVIII of the Social Security Act) . The Medical Assistance Program is a joint federal-state program funded under Title XIX of the Social Security Act. The
5

Department of Public Welfare administers the Medical Assistance Program in Pennsylvania. As a prerequisite to enrollment 'as a provider in the Medical Assistance Program, all of the long-term care facilities that are the subject of this Complaint entered into provider agreements and agreed to the following provisions:
1. That the submission by, or on behalf of, the Facility of any claim, either by.hard copy or electronic means, shall be certification that the services or items from which payment is claimed actually were provided to the person identified as a medical assistance resident by the person or entity identified as the Facility on the dates indicated.
*******
5. That the Facility's participation in the Medical Assistance Program is subject to the laws and regulations effective as to the period of participation, including all of those that may be effective after the date of the agreement and that the Facility has the responsibility to know the law with respect to participation in the Medical Assistance Program. At all times relevant to this action, Chester Care Center, Bishop Nursing Home and Manchester House Nursing & Convalescent Center were "providers" with valid provider agreements with the Pennsylvania Department of Public Welfare.
6

The Nursing Home Reform Act also mandates that the State shall be responsible for certifying, in accordance with surveys conducted by the state, the compliance of nursing facilities (other than facilities of the state) ... The Secretary [Department of Health and Human Services] shall be responsible for certifying .•. , the compliance of State nursing facilities with the requirements of such subsections. 42 U.S.C.A. §1396r(g) (1) (A).
The Pennsylvania Department of Health is responsible for performing the survey function of long-term care facilities in Pennsylvania. By state regulation, facilities are required to meet the daily nutritional needs of patients. 28 Pa. Code § 211.6(a). Additionally, if consultant dietary services are used, the consultant's visits must be at appropriate times and of sufficient duration and frequency to provide continuing liaison with medica.l and nursing staff and provide advice to the administrator and participate in the development and revision of dietary policies and procedures. 28 Pa. Code § 211.6(m).
Long-term care facilities are also required to provide nursing services that meet the needs of residents. The facility must hav~sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. 42 C.F.R. §483.30. See also 28 Pa. Code § 211.12(a). There must
7

be adequate staff to provide nursing care to all residents in accordance with resident care plans. 42 C.F.R. §483.30(a) {l). It is 'incUl11bent upon the director of nursing services to assure that "preventive measures, treatments, medications, diet and other health services prescribed are properly carried out ... " 28 Pa. Code § 211.12 (e) (9) .
Moreover, a nursing facility is required to retain a medical director who is responsible for the "coordination of the medical care in the facility to ensure the adequacy and appropriateness of the medical services provided to patients." 28 Pa. Code § 211.2(k).
Finally, a nursing home administrator is charged with the general administration of the facility whether or not his or her functions are shared with one or more other individuals. 63 P.S. § 1102(2). According to regulations promulgated by the Nursing Home Administrators Board, a nursing home administrator is responsible for: (a) evaluating the quality of resident care and efficiency of services, (b) maintaining compliance with governmental regulations, and (c) developing policies which govern the continuin~care and related medical and other services provided by th~facility which reflect the. facility's philosophy to provide a high level of resident care in a healthy, safe and comfortable environment. 49 Fa. Code §§ 39.91(1) (i), (ii), (vi).
The Government's complaint charges that the defendants caused the submission of false or fraudulent claims to the United
8

States for payment for care that was not adequately rendered to frail and vulnerable elderly residing at Chester Care Center and Bishop Nursing Home. The Health Care Financing Administration imposed civil money penalties against Manchester House Nursing & Convalescent Center, Bishop Nursing Home and Chester Care Center based upon survey deficiencies discovered during 1996 and 1997.
FACTUAL BASIS FOR COMPLAINT RESIDENT 1
Resident 1, a resident of Chester Care Center, was a diabetic who suffered from multiple, severe conditions. Resident l's vital signs were taken daily from December 15, 1995 to December 19, 1995. A blood glucose of 20 mg/dl was reported on 12/18, a seriously low level capable of causing coma. The nursing note indicated that the action taken would be to "report to next shift to call MD with result." No further vital signs nor clinical assessments were recorded despite a potentially coma-causing blood glucose level. There were no adequate assessments performed by the staff and Resident 1 ultimately became unresponsive on January 2, 1996. Resident 1 died of sepsis and diabetic hyperosmolar coma at Crozer-Chester Medical Center. RESIDENT 2
Resident 2, a resident of Chester Care Center who was unable to speak, was admitted to Crozer-Chester Medical Center on January 3, 1996 with a diagnosis of full thickness burns over 43%
9

of her body surface area involving the upper and lower limbs and portion of the right buttock and pelvic area. Resident 2 had been placed in a tub of hot water for a bath by a certified nurse aide. The water temperature, when measured after the incident, was 138 degrees Fahrenheit. Chester Care Center had knowledge of the malfunctioning boiler and been cited by the state Department of Health in prior surveys for improper water temperatures and had submitted a plan of correction to address this issue. On January 6, 1996, Resident 2 died of shock and sepsis due to thermal burns of the body. RESIDENT 3
Resident 3, a resident of Bishop Nursing Home, suffered from progressive weight loss without adequate dietary interventions to reverse his progressive deterioration. Resident 3 weighed 149 pounds in early 1995 which declined to 128 pounds by October 1995. By May 1996, his weight was 125 pounds and at a hospital admission in August 1996, he weighed 113 pounds. From February 1994 to May 1996, Resident 3's serum albumin level declined from 3.6 gm/dl to 2.5 gm/dl. Resident 3 had been hospitalized in February 199&: for 3 days and was hospitalized in May 1996 for 13 days for ~~rition. Resident 3's weight declined further to 105 pounds by November 1996 and at autopsy (February 1997), he weighed 88 pounds. Resident 3 also suffered from multiple decubitus ulcers at his hip, sacrum and genital area, which were
10

not healing over time. There was no underlying condition that would cause Resident 3 to lose weight and develop pressure sores. RESIDENT 4
Resident 4, a resident of Chester Care Center, suffered from a marked, persistent functional decline that was not addressed by the medical care rendered at the facility. There were disparities between the recorded vital. signs at the facility and those recorded at the hospital. Resident 4's ideal body weight was 139 pounds which declined to 105 pounds in January 1996. Even though assessments written by registered dieticians clearly identified inadequate protein being recommended for this resident, the assessments were nonetheless implemented. Timely assessments of weight and protein status and revision of the nutrient prescription when it failed to achieve its stated goals were non-existent. Additionally, there was no discussion of the problem of recurrent aspiration pneumonia in a resident receiving continuous feedings through a PEG tube. No alternative options, including placement of a jejunostomy tube were ever considered. Finally, there was no intervention to alter the frequent transfers ot tha resident from Chester Care Center to the hospital, as her functional level declined and she repeatedly reaspirated. In fact,· there was little evidence contained in her chart that Resident 4 received adequate nutritional or physical care, or comfort at Chester Care Center to mitigate the pain and
11

suffering from repeated hospitali~ations during her fatal decline. RESIDENT 5
Resident 5, a resident of Chester Care Center, was admitted to the facility in February 1995 weighing 170 pounds, 101% of his ideal body weight. Resident 5 was a diabetic and during his stay over the next 10 months, experienced five hospitalizations. After his first hospitalization in March 1995, Resident 5's albumin was 3.2 gm/dl, and his weight was 171 pounds. Resident 5 was still independent in eating and was continent. After his second hospitalization in May 1995, Resident 5's weight was 165 pounds and he was incontinent of bowel and bladder, but otherwise was able to assist with his care and was mobile. During the subsequent four months (May 1995 to September 1995), Resident 5 developed a progressive anemia and hypoalbuminemia. Resident 5's weight declined to 158 pounds and there was no evidence in his chart of efforts to restore continence. As of October 1995, Resident 5 rrad developed seven wounds, including one Stage III and four Stage II pressure ulcers. Resident 5 was hospitalized for an aspiration pneumonia and hypergylcemia in December 1995. Until hi$~ina~·transfer to an acute care facility, Resident 5 had several episodes of hypoglycemia without readjustments in his insulin or feeding. Nursing and medical inattention to reversing the downward spiral of loss of mobility, loss of continence, and
12

loss of muscle mass leading to further immobility, facilitated the functional decline of Resident 5 until his demise.
Jurisdiction and Venue 1. This Court has ju~isdiction over this action pursuant to 28 U.S.C. §§ 1331, 1345 and 31 U.S.C. § 3729 et ~. 2. Venue is proper in the Eastern District of Pennsylvania under 28 U.S.C. §§ 1391 (b) and (c).
Parties 3. Plaintiff is the United States of America acting for itself, the Department of Health and Human Services-Of~ice of Inspector General, the Health Care Financing Administration, the Medicare Trust Fund, the Medical Assistance Program and the beneficiaries thereof. 4. Defendant, Chester Care Center is a licensed and certified long-term care facility located at 15th Street & Shaw Terrace, Chester, Pa. 19013. 5. Defendant, Bishop Nursing Home is a licensed and certified long-term care facility located at 318 South Orange Street, Media, Pa. 19063. 6. Defendant, Manchester House Nursing & Convalescent
Center is a licensed and certified long-term care facility
located at 411 Manchester Avenue, Media, Pa. 19063. 7. Defendant, The Bishop Nursing Home Inc, is a for-
profit corporation that is the owner and licensee of Bishop
13

Nursing Home and has corporate offices located at 555 East Baltimore Avenue, Media, Pa. 19063.
8. Defendant, Commonwealth Real Estate Investors is a partnership that is the owner and licensee of Chester Care Center and Manchester Nursing & Convalescent Center and partner of The Bishop Nursing Home, Inc., with corporate offices located at 111 South Avenue, Media, Pa. 19063.
COUNT I FALSE CLAIMS ACT: 31 U.S.C. § 3729 9. The above paragraphs are realleged as though fully set forth herein. 10. The provision of adequate nutrition to residents of defendants' long-term care facilities was the responsibility of not only the nutritionists and dietary staff but included the nu~sing and medical staff as well. 11. The provision of adequate wound care to residents of defendants' long-term care facilities was the responsibility of the nursing and medical staff. 12. The provision of adequate care to residents with diabetes included all disciplines, including but not limited to medical, nursing, and dietary staff. 13. The provision of adequate care during the bathing of residents of defendant Chester Care Center was the responsibility of the nursing staff and management which was aware of prior boiler problems at defendant Chester Care Center.
14

14. Agents and/or employees of defendants were responsible for the provision of nursing, wound care and nutritional services to Residents 1, 2, 3, 4 and 5 as well as to all of the residents of defendants' long-term care facilities.
15. Defendants billed the government for care provided to Residents 1, 2, 3, 4 and 5 and for other residents of their facilities for reimbursement by the Medicare and Medical Assistance Programs.
16. Agents and/or employees of defendants, Chester Care Center, Bishop Nursing Home, The Bishop Nursing Home, Inc. and Commonwealth Real Estate Investors, submitted false, fictitious or fraudulent claims to the Pennsylvania Department of Public Welfare, Medical Assistance Program for nutritional, nursing, dietary, plant management and wound care services that were not adequately rendered to Residents 1, 2, 3, 4, and 5 for the time period June 1995 through the present.
17. Defendants, Commonwealth Real Estate Investors and The Bishop Nursing Home, Inc., as licensees for Chester Care Center anCL81shop'Nursing Home, were responsible for the care rendered, t(ll. residents at defendants' facilities and caused the repeated submission of. false, fictitious or fraudulent claims to the Pennsylvania Department of Public Welfare, Medical Assistance Program, and to the Medicare Program for nutritional, wound care and nursing services that were not adequately rendered to
15

--------~--------------------~-------------
Residents 1, 2, 3, 4 and 5 for the time period June 1995 through the present. 31 U.S.C. § 3729.
18. Defendants knowingly and willfully did not ascertain the truth or falsity of the claims for services submitted to the Pennsylvania Department of Public Welfare and to the Medicare Program for payment on behalf of Residents 1, 2, 3, 4 and 5, all of whom were Medical Assistance recipients and Medicare beneficiaries. 31 U.S.C. § 3729.
19. Defendants acted in reckless disregard of the care and services ordered and actually provided to Residents 1, 2, 3, 4 and 5 while residing at Chester Care Center and Bishop Nursing Home when billing the Medicare and Medical Assistance Programs. 31 U.S.C. § 3729.
20. Defendant, Manchester House Nursing & Convalescent Center was cited for deficiencies and HCFA imposed civil money penalties in March 1996 after a re-visit found similar deficiencies, including deficiencies pertaining to the treatment of pressure sores.
21. Defendant, Commonwealth Real Estate Investors, as
licensee for Manchester House Nursinq & Convalescent Center, was
responsible fo~ ana received payment from government programs (Medicare and Medicaid~ for inadequate care rendered to residents of Manchester House Nursing & Convalescent Center.
22. Upon information and belief, the United states alleges that the care provided to Residents 1, 2, 3, 4, and 5
16

was representative of the inadequate care rendered to residents of defendants' long-term care facilities. The care rendered was inadequate in terms of medical care, nursing care, nutrition, and diabetic care, all of which were the responsibility of the defendants' Nursing Horne Adrninistrators~ the Medical Directors and the Directors of Nursing. The claims submitted by defendants for the care of these residents would thus constitute false claims actionable under the False Claims Act to the same extent as the claims for Residents 1-5.
23. The United states was damaged as a result of the conduct described above.
WHEREFORE, plaintiff United states of America demands and prays that judgment be entered in its favor and against the defendants, jointly and severally as follows:
a. an amount equal to the number of false or fraudulent claims that will be proven at trial, multiplied as provided for in 31 U.S.C. § 3729(a) and imposition of $10,000.00 per claim;
b:"threetimes that total amount of damages sustained
o. by the United states because of the acts complained of; ~i~sts this action; ..~",!!." ~su~other and further relief as the Court shall
deem proper...·
17

COUNT I I: UNJUST ENRICHMENT 25.·· The foregoing paragraphs are incorporated herein by reference as if fully set forth. 26. The conduct descr~bed in the foregoing paragraphs caused all defendants to receive, directly or indirectly, benefits from the United States. 27. Under the circumstances described in the foregoing paragraphs, as between the United States and each defendant in this Count, retention by each defendant of the benefits conferred by the United States would be unjust. WHEREFORE, plaintiff the United States of America demands judgment in its favor and against defendants, jointly and severally, and relief as follows: a. an amount equal to the gain to the defendants as a result of the activities complained of; b. interest according to law; c. costs of this action; and
18

d. such other and further relief as this Court may deem proper.
Respectfully submitted,
..
~C~~
MICHAEL R. STILES UNITED STATES ATTORNEY
Dated: 1/13/98
19

 
 United States District Court Eastern District of Pennsylvania - Docket Report

Page 1 of 5

CLOSED, STANDARD
United States District Court Eastern District of Pennsylvania (Philadelphia) CIVIL DOCKET FOR CASE #: 2:98-cv-00139-LP

UNITED STATES v. CHESTER CARE CENTER, et al Assigned to: JUDGE LOUIS H. POLLAK Demand: $0 Cause: 31:3729 False Claims Act

Date Filed: 01/13/1998 Jury Demand: None Nature of Suit: 890 Other Statutory Actions Jurisdiction: U.S. Government Plaintiff

Plaintiff UNITED STATES OF AMERICA

represented by DAVID R. HOFFMAN U.S. ATTORNEY'S OFFICE 615 CHESTNUT ST. SUITE 1250 PHILADELPHIA, PA 19106-4476 215-861-8337 Fax: 215-861-8594 Email: david.hoffman@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

JAMES G. SHEEHAN U.S. ATTORNEY'S OFFICE 615 CHESTNUT ST SUITE 1250 PHILADELPHIA, PA 19106-4476 215-861-8301 Fax: 215-861-8647 Email: james.sheehan@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

MICHAEL R. STILES UNITED STATES ATTORNEY 615 CHESTNUT STREET SUITE 1250 PHILADELPHIA, PA 19106 TEL 215-861-8501 Fax: FAX 215-861-8618 LEAD ATTORNEY ATTORNEY TO BE NOTICED

V. Defendant

https://ecf.paed.uscourts.gov/cgi-bin/DktRpt.pl?612774163553645-L_923_0-1

10/19/2005

United States District Court Eastern District of Pennsylvania - Docket Report

Page 2 of 5

CHESTER CARE CENTER TERMINATED: 05/07/2002
Defendant BISHOP NURSING HOME TERMINATED: 05/07/2002
Defendant MANCHESTER HOUSE NURSING & CONVALESCENT CENTER TERMINATED: 05/07/2002
Defendant THE BISHOP NURSING HOME, INC.
Defendant

represented by JOHN C. DODDS MORGAN LEWIS & BOCKIUS 1701 MARKET STREET PHILADELPHIA, PA 19103-2921 215-963-4942 Email: jdodds@morganlewis.com TERMINATED: 05/07/2002 LEAD ATTORNEY
WALTER M. STRINE, JR. 300 W. STATE STREET SUITE 300 MEDIA, PA 19063 TERMINATED: 05/07/2002 LEAD ATTORNEY
represented by JOHN C. DODDS (See above for address) TERMINATED: 05/07/2002 LEAD ATTORNEY
WALTER M. STRINE, JR. (See above for address) TERMINATED: 05/07/2002 LEAD ATTORNEY
represented by JOHN C. DODDS (See above for address) TERMINATED: 05/07/2002 LEAD ATTORNEY
WALTER M. STRINE, JR. (See above for address) TERMINATED: 05/07/2002 LEAD ATTORNEY
represented by JOHN C. DODDS (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
WALTER M. STRINE, JR. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

https://ecf.paed.uscourts.gov/cgi-bin/DktRpt.pl?612774163553645-L_923_0-1

10/19/2005

United States District Court Eastern District of Pennsylvania - Docket Report

Page 3 of 5

COMMONWEALTH REAL ESTATE INVESTORS

represented by JOHN C. DODDS (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
WALTER M. STRINE, JR. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 01/13/1998 01/13/1998 01/13/1998 01/15/1998
02/04/1998
02/04/1998 01/03/2000
01/04/2000
01/05/2000

#

Docket Text

1 Complaint. (fe) (Entered: 01/13/1998)

Summons(es) issued. Six Originals Forwarded to: counsel 1/13/98. (fe) (Entered: 01/13/1998)

Standard Case Management Track. (fe) (Entered: 01/13/1998)

2 Praecipe by PLAINTIFF UNITED STATES to Substitute the original signature of Lewis Morris, and Walter M. Strine, Jr., for the copy in the Consent Decree filed 1/13/98. (fe) (Entered: 01/16/1998)

3 CONSENT ORDER AND JUDGMENT RE: SETTLEMENT. ( SIGNED BY JUDGE LOUIS H. POLLAK ) 2/5/98 ENTERED AND COPIES MAILED. (fe) Modified on 02/05/1998 (Entered: 02/05/1998)

Case closed (jmp) (Entered: 02/09/1998)

4 MOTION by PLAINTIFF UNITED STATES FOR ORDER TO SHOW CAUSE WHY DEFTS SHOULD NOT BE HELD IN CONTEMPT , MEMORANDUM, CERTIFICATE OF SERVICE. (af) (Entered: 01/04/2000)

5 Praecipe by PLAINTIFF UNITED STATES to delete unredacted pages of UNITED STATES OF AMERICA'S MOTION FOR ORDER TO SHOW CAUSE WHY DEFENDANTS SHOULD NOT BE HELD IN CONTEMPT. (Copy of original filing attached, with pages deleted) (md) (Entered: 01/05/2000)

6 ORDER THAT DEFTS MANCHESTER HOUSE NURSING & CONVALESCENT CENTER, AND COMMONWEALTH REAL ESTATE INVESTORS, INCLUDING WALTER STRINE, JR., OWNER OF THE DEFTS, AND THE NURSING HOME ADMINISTRATOR OF MANCHESTER HOUSE NURSING, KATHY GILLAN, SHALL APPEAR BEFORE THIS COURT ON 1/11/00 AT 8:30 TO SHOW CAUSE WHY DEFTS SHOULD NOT BE HELD IN CIVIL CONTEMPT FOR FAILING TO MEET THEIR OBLIGATIONS UNDER THE CONSENT ORDER OF 2/5/98. FAILURE TO APPEAR SHALL BE CAUSE FOR A FINDING OF CONTEMPT. ( SIGNED BY JUDGE LOUIS H. POLLAK ) 1/5/00 ENTERED AND COPIES MAILED AND FAXED BY CHAMBERS. (md) Modified on

https://ecf.paed.uscourts.gov/cgi-bin/DktRpt.pl?612774163553645-L_923_0-1

10/19/2005

United States District Court Eastern District of Pennsylvania - Docket Report

Page 4 of 5

01/14/2000
01/19/2000 03/29/2001 04/02/2001 04/24/2002 05/07/2002

01/05/2000 (Entered: 01/05/2000)
7 STIPULATED ORDER THAT MANCHESTER HOUSE VOLUNTARILY BANS ALL NEW RESIDENT ADMISSIONS, UNTIL THE COURT FINDS THAT NEW RESIDENT ADMISSIONS ARE APPROPRIATE; DEFTS COMMONWEALTH REAL ESTATE, AND MANCHESTER HOUSE, AGREE TO THE APPOINTMENT OF A TEMPORARY MGR.; THE COURT HEREBY APPOINTS THE WHITMAN GROUP AS THE TEMPORARY MGR. WITH FULL AUTHORITY TO OPERATE MANCHESTER HOUSE AS SET FORTH IN THIS STIPULATED ORDER; THIS STIPULATED ORDER IS ENTERED BY THE COURT PURSUANT TO THE ATTACHED LETTER OF 1/14/00, TO THE COURT, FROM ASST. US ATTY DAVID R. HOFFMAN, ATTY FOR THE PLFF, WHICH LETTER WAS COPIED TO JOHN C. DODDS, ESQ., ATTY FOR THE DEFTS. ( SIGNED BY JUDGE LOUIS H. POLLAK ) 1/18/00 ENTERED AND COPIES MAILED. (md) (Entered: 01/18/2000)
8 Minute entry re: 1/13/00 hearing/conference. Court addresses counsel. Mr. Dodds addresses Court. Mr. Hoffman addresses Court. Court colloquy with counsel. Hearing set for 1/14/00 at 11:00. (md) Modified on 01/19/2000 (Entered: 01/19/2000)
9 STIPULATED MOTION by DEFENDANT COMMON REAL, DEFENDANT THE BISHOP NURSING, DEFENDANT CHESTER CARE CENTER, DEFENDANT BISHOP NURSING HOME, DEFENDANT MANCHESTER HOUSE NUR TO RESCIND APPOINTMENT OF TEMPORARY MANAGER , CERTIFICATE OF SERVICE. (ph) (Entered: 03/30/2001)
10 STIPULATION AND ORDER THAT COURT'S 1/14/00 STIPULATED ORDER IS HEREBY RESCINDED IN ALL RESPECTS, ETC. ( SIGNED BY JUDGE LOUIS H. POLLAK ) 4/2/01 ENTERED AND COPIES MAILED AND FAXED. (jl) (Entered: 04/02/2001)
11 JOINT MOTION by PLAINTIFF UNITED STATES, DEFENDANT COMMON REAL, DEFENDANT THE BISHOP NURSING, DEFENDANT CHESTER CARE CENTER, DEFENDANT BISHOP NURSING HOME, DEFENDANT MANCHESTER HOUSE NUR TO DISMISS ACTION , MEMORANDUM, CERTIFICATE OF SERVICE. (afm) (Entered: 04/24/2002)
12 ORDER THAT PARTIES' JOINT MOTION TO DISMISS ACTION IS GRANTED, DEFENDANTS' CHESTER CARE CENTER, BISHOP NURSING HOME AND MANCHESTER HOUSE NURSING & CONVALESCENT ARE DISMISSED WITH PREJUDICE. REMAING DEFENDANTS' SHALL CONTINUE TO COMPLY WITH CONSENT ORDER ENTERED ON 2/5/1998. ( SIGNED BY JUDGE LOUIS H. POLLAK ) 5/7/02 ENTERED AND COPIES MAILED AND FAXED. (afm) (Entered: 05/07/2002)

https://ecf.paed.uscourts.gov/cgi-bin/DktRpt.pl?612774163553645-L_923_0-1

10/19/2005

United States District Court Eastern District of Pennsylvania - Docket Report

Page 5 of 5

PACER Service Center
Transaction Receipt

10/19/2005 18:04:14

PACER Login: hs0328

Client Code:

Description: Docket Report Search Criteria: 2:98-cv-00139-LP

Billable Pages: 2

Cost:

0.16

https://ecf.paed.uscourts.gov/cgi-bin/DktRpt.pl?612774163553645-L_923_0-1

10/19/2005

 
 U.S. Department of Justice
United States Attorney
h t e r n District of Pennsylvania
615 Chestnut Street Suite 1250 Philadelphia, Pennsyhania 19106-4476 (215) 451-5200
January 13, 1998
PRESS RELEASE
Michael R. Stiles, United States Attorney for the Eastern District of Pennsylvania, Michael Little, Regional Inspector General for Investigations, Department of Health and Human Services and Judith Berek, Acting Regional Administrator for the Philadelphia Regional Office, Health Care Financing Administration (HCFA), today announced the filing of a civil False Claims Act Complaint against three nursing homes located in Delaware County for the provision of inadequate care to their residents. A Consent Order was filed simultaneously with the Federal District Court in which the owner of the facilities agreed to pay the federal government $500,000 and to implement a comprehensive compliance program to settle claims resulting from an investigation into the quality of care provided to residents from June 1995 to the present.
In its Complaint against Chester Care Center, Bishop Nursing .Home, and Manchester House Nursing C Convalescent Center and their corporate owners, the government charged that the defendants did not render adequate care 'to their residents and the Complaint specifically identifies 5 residents for whom the government was paying who were not adequately cared for by the defendants.
Specif.ically, the care rendered to 3 residents of Chester Care Center with diabetes was inadequate in terms of monitoring and responding to complications associated with diabetes, and the provision of nutrition and wound care.
Another individual, a resident of Chester Care Center, was scalded to death when a nurses' aide placed the resident, who was unable to speak, ihto 138 degree Fahrenheit water during a bath. The government's Complaint alleges that the defendants knew that there were problems with the water temperature and did not adequately address that issue. The nurses" aide has been criminally charged by the state Attorney General's Office.

The final victim, a resident of Bishop Nursing Home, was allegedly improperly cared for in terms of his nutrition and wound care while the facility billed the Medicaid program for his care. The government alleged that the facility did not respond to this resident's weight loss in a timely fashion and as a result he developed pressure sores (decubitus ulcers) which were not properly treated.
U.S. Attorney Stiles stated that this False Claims Act case was the second of its kind in the country pertaining to quality of care in the nursing home environment and should once again serve notice to the nursing home industry that a failure to provide adequate care to some of the most frail and vulnerable .members of society will not be tolerated. "Quality of care for those residing in nursing homes must be protected by all means possible,'" Stiles noted.
In addition to the payment, the terms of the Consent Order apply to approximately 700 residents and require:
-State-of-the-art treatment protocols for residents with diabetes;
-Retention of a temporary manager for ~hesterCare Cent.er to manage the facility and ensure compliance with federal law and regulations;
-A full-time federal monitor for all three facilities for at least two years;
-.Provisionof wound care in accordance with the Agency for Health Care Policy and Research .(AHCPR) guidelines and enhanced nutrition protocols;
-~evelopmentof a'corporate compliance program that ensures appropriate responses to, among other items, weight loss, wound care and diabetic care;
-Training of staff on all issues contained in the Consent Order.
The development of the protocols for this case was done with invaluable assistance from the following individuals:
Stanley Schwartz, M.D.
Bruce Kinosian, M.D. ,
Ilene Warner, R.N., C, CWCN, Barbara J. Maschak-Carey, R.N., M.S.N., Sue Bradley, R.N., C

This case also included support from representatives of the Pennsylvania Department of Health and Department of Public Welfare.
The case was handled by Assistant United States Attorney David R. Hoffman.