Industrial Science Hunts For Nursing Home Fraud In New Mexico Case : Shots - Health News New Mexico is using time-motion studies to sue a chain of nursing homes for fraud. State prosecutors say the facilities couldn't possibly have provided the care promised — and billed for.

Industrial Science Hunts For Nursing Home Fraud In New Mexico Case

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In New Mexico, the attorney general is suing a chain of nursing homes. The state says the facilities were so understaffed they couldn't possibly provide the care they were billing for and it wants its money back. Across the country, about a quarter of all nursing home complaints are because of insufficient staff. Studies connect those low levels to lousy treatment. NPR's Ina Jaffe has been looking into the New Mexico case and talking to family members.

INA JAFFE, BYLINE: It was a tough decision for Lino Lucero and his wife Linda to send Linda's mother to a nursing home. But Alzheimer's continued to tighten its grip on her and they'd done everything they could at home.

LINO LUCERO: It got to the point where it was making my wife sick trying to deal 24 hours a day with her.

JAFFE: So in 2007, Lucero and his wife brought his mother-in-law, Polly Duran, to a nursing home in Santa Fe called Casa Real. They visited frequently, sometimes daily. There were always appalling discoveries.

LUCERO: Not to be a distasteful person, but the smell and the stench you could tell - and not only from her but for the other residents that were there - was horrible and deplorable. You'd walk in and you'd wish you had a mask.

JAFFE: Linda Lucero frequently cleaned her mother up and changed her sheets. The Luceros also noticed that Polly Duran was losing weight, growing frail. Apparently, the staff did not always cut up her food as the doctor ordered, so sometimes she didn't eat. The last straw was when the Luceros got a call from a hospital in Santa Fe. The doctor said that Polly Duran had just been admitted.

LUCERO: And we said, well, what's was wrong? And she said she has a broken hip and it's severely broken. And it looks like it's been broken for more than three or four days.

JAFFE: The Lucero's never found out why it took the staff at Casa Real three days to do something about a broken hip. Polly Duran never walked again and died several months later. But her experience is the reason that Lino Lucero became confidential witness number one in the lawsuit against Cathedral Rock, which owned the nursing home then, and Preferred Care Partners Management Group, which owns it now.

HECTOR BALDERAS: These are companies that profited and made hundreds and hundreds of millions of dollars in revenue.

JAFFE: Eighty percent of which came from the state of New Mexico in the form of Medicaid payments, says Hector Balderas, New Mexico's Attorney General. He's suing Casa Real and six more nursing homes owned by Preferred Care Management Group.

BALDERAS: We're trying to recover dollars back for the taxpayers of New Mexico.

JAFFE: And for private pay residents he says were bilked.

BALDERAS: But most importantly, this is about disabled populations and elderly populations who suffered unnecessarily sitting there in their own feces, sitting there in urine, developing bedsores. And some of this lack of care even resulted in death.

JAFFE: So far, there are 31 confidential witnesses in this case - families like the Luceros and former employees. But what makes New Mexico's suit novel isn't the personal accounts, it's the data. The state used an industrial engineering model that shows how long it takes healthcare staffers to do individual tasks. They focused on activities considered basic care - things like bathing, feeding and turning patients so they don't get bedsores. The Attorney General's office then compared this with the care required by the actual residents of the targeted nursing homes. Their conclusion - it was physically impossible for the number of people employed at these nursing homes to provide the care required by the residents. And when the nursing homes billed for that care, they were lying. Which is nonsense, says Deborah Mann, an attorney for Preferred Care Partners Management Group.

DEBORAH MANN: This simulation reinvents the wheel.

JAFFE: Mann says that's because there already is a legal standard of care in New Mexico. It's two and a half hours of nursing care per patient per day on average.

MANN: That's the standard that was published to the industry. That's the standard that the people who run the nursing homes knew about. And to try to hold somebody in retrospect liable for essentially lying is unfair.

BALDERAS: Simply following regulation is not enough.

JAFFE: Says New Mexico Attorney General Hector Balderas.

BALDERAS: Those are minimal standards - just a basic floor. They should be doing everything they can to make sure that the health, safety and welfare of these residents is met.

JAFFE: That view is basically a condensed version of the federal standards for nursing homes. Attorneys for the other defendant Cathedral Rock declined to comment. But that company previously settled federal, civil and criminal complaints for negligence and fraud in its Missouri nursing home, paying more than 1.6 million dollars in fines. As for Preferred Care, all but one of their nursing homes targeted in this suit have received bad grades from the federal government. Lino Lucero wants them held accountable for the way they treated his mother-in-law.

LUCERO: It's amazing to me that you place the trust and the love of someone that you care for and you put it into somebody's hands and it's the neglect and the abuse of that person and their spirit is completely broken and lost.

JAFFE: The pain of witnessing that, he says, stays with you for life. Ina Jaffe, NPR News.

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