FALSE CLAIMS

$2.75 billion fraud recoveries so far in 2024

Long-term care providers criminally charged by the Justice Department led to the recovery of more than $2.75 billion in false claims against healthcare providers. Many of the cases involve nursing homes, home health or hospice agencies, and assisted living providers, according to the report from the department’s criminal division.

Complying with audit and survey requests can place demands on already stretched human and financial resources. Excelas works to support the regulatory audit and survey process with services geared toward ensuring an expedient and complete response to the challenges at hand.

RISK MANAGEMENT

Likelihood of unavoidable pressure ulcers merits new warning process

Seasoned medical malpractice attorneys have recommended a new warning process for “unavoidable” pressure ulcers using a standardized More Likely than Not form, even though that form would not work as a strict liability waiver, to help fend off related litigation.

“Many pressure ulcers are unavoidable, but patients-turned-litigants do not seem to know that fact even when they develop a pressure injury incident to treatment that saved their lives,” the attorneys wrote in the National Law Review. “The volume of pressure ulcer cases is not a result of prevalent negligence, but of a dearth of aggressive defense strategies leading to costly settlements in cases in which good care was provided and ulcers were foreseeable and unavoidable.”

The Agency for Healthcare Research and Quality has reported 2.5 million patients per year experience pressure ulcers (also called pressure injuries), costing the healthcare system between $9.1 billion and $11.6 billion. In addition, the agency found more than 17,000 lawsuits are related to pressure ulcers annually, making it the second-most common healthcare claim after wrongful death.

NURSING HOMES

10 Nutritional considerations for long-term care residents

Nutrition is a major focus at many nursing facilities because it is often linked to medical conditions. Malnutrition and dehydration, in particular, are recurring issues at nursing facilities, especially because they can lead to falls, the development of pressure injuries and/or cognitive impairment.

DEFENSE STRATEGY

Reptile defense tactics: priming in voir dire

By the time a case reaches trial, the plaintiff attorney has already been busy laying the foundation for Reptile Theory arguments. Savvy defense attorneys must lay their own foundations by successfully training their witnesses to avoid reptile traps during deposition and testimony. But with the opening of trial comes voir dire—the next stage at which the defense can take aim against Reptile maneuvering.

In a medical malpractice case, medical records can help defense attorneys decide what concepts or key themes to focus on in voire dire. A detailed Case Summary provides a concise, narrative-style review of the plaintiff’s medical history, encompassing all care providers and care settings. It should include an objective assessment of the case’s strengths and weaknesses and an evaluation of whether or not the standard of care was met.

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