Los Angeles Nursing Homes Manipulating Patients' Medical Conditions for Their Own Personal Gain

January 16, 2012

Recently, as reported by The Baltimore Sun on January 12, 2012, certain health care groups have been engaging in a practice called "upcoding." This increasingly prevalent practice involves healthcare providers reporting more serious medical conditions to the government, in order to receive higher reimbursement rates. In this specific case, an orthopedic company was accused of manipulating patients' files to make it seem as though patients had a serious form of malnutrition, called kwashiorkor. The company denies these claims and is fighting back.

However, malnutrition is a serious problem that must not be underestimated. The most obvious sign of malnutrition is weight loss. Malnutrition has many health implications, including pressure ulcers, infections, pneumonia, and falls.

Usually, malnutrition is a direct result of understaffing. When there are not enough nurses working during mealtimes, residents do not receive the proper food and nutrition that they need. Furthermore, mealtime should be a time for positive social engagement, which must be initiated and encouraged by nurses. Often, nursing homes appear to be fully staffed during day shifts, but during night shifts and mealtimes they are actually inadequately staffed. When choosing a skilled nursing facility for your loved one, make sure to visit during mealtimes so that you can get a first-hand experience of what your loved one's mealtimes will be like. If possible, try a sample of the food your loved one will be eating, and check if a dietician is present. You should also make sure that your loved one is not suffering from dehydration, which often accompanies malnutrition.

Interestingly enough, while some healthcare facilities are "upcoding," others are "downcoding." Although "downcoding" entails that the facility receives less funding from the government, nursing homes use this practice to lower their liability. For example, pressure ulcers are relatively easy to downcode because there are different levels of severity. Instead of accurately diagnosing a pressure sore as stage four, which is very serious, nursing homes often claim ignorance and diagnose these sores as being in their early stages of development. They allow patients to continue suffering until the problem is so serious that they must be sent to the hospital. At this point, nurses often claim that previously, the sore was not a severe one, and that it just recently developed into a stage four pressure ulcer. This allows them to attempt pass the responsibility on to the hospital or new care facility to which the patient is transferred. Once again, the development of pressure ulcers, as well as any other health ailments in nursing homes, is usually a direct consequence of understaffing. Regardless, nurses are fully responsible for the prevention of pressure ulcers, and must also be knowledgeable enough to accurately diagnose them, when necessary.

While the list of problems experienced in skilled nursing facilities is extensive, the main purpose of this blog is to emphasize how simple it is for healthcare facilities to manipulate their patients' health records. For this reason, it is imperative that you are extremely cautious in allowing others to care for your loved one. Even if the facility makes claims and promises to you, it is important for you to ensure that the caretakers are following through with these promises. If you notice that something is wrong, or if your loved one is diagnosed with an illness, we advise you to get a second opinion. All too often, the elderly are taken advantage of and forced to suffer because skilled nursing facilities misdiagnose their patients. Do not allow this to happen to you or your loved one.

If you have a loved one who has been injured in a Los Angeles county nursing home, contact us today to see how we can help.