Press Release  AG Healey Secures $1.75 Million Resolution With Nursing Home Chain Over Failure To Meet the Needs of Residents With Substance Use Disorder

BOSTON — A Connecticut-based long-term care management company operating nursing homes across southern New England has agreed to pay $1.75 million and adopt a series of critical compliance measures in a settlement reached by Attorney General Maura Healey’s Office. The settlement resolves a series of allegations, including that the company failed to meet the needs of nursing home residents experiencing substance use disorder (SUD). The largest nursing home settlement ever reached by the AG’s Office, these funds will be directed to the state’s Opioid Recovery and Remediation Trust Fund for prevention, harm reduction, treatment, and recovery across Massachusetts.

Athena Health Systems (Athena) of Farmington, Connecticut owns, operates, and manages skilled nursing homes and hospice facilities throughout New England, including Marlborough Hills Rehabilitation & Healthcare Center of Marlborough; Highview of Northampton; and Parsons Hill Rehabilitation & Healthcare Center and Worcester Rehabilitation & Healthcare Center, both of Worcester. The AG’s Office investigated reports of substandard care or regulatory violations at these nursing homes that allegedly started in March 2016, based on complaints referred by the Massachusetts Department of Public Health (DPH) and the Office of the Long Term Care Ombudsman.

“Every nursing home resident deserves to live in a safe environment, with dignity and access to high-quality care,” said AG Healey. “This resolution ensures that Athena facilities will appropriately provide care for individuals with substance use disorder and helps to restore the trust families need when making critical decisions about the care of their loved ones.”

Skilled nursing facilities participating in Medicare and MassHealth must follow various state and federal statutes, regulations, and rules governing their procedures and conduct.

The AG’s Office alleges that the Athena facilities, at the direction of Athena, admitted substantial numbers of residents with histories of substance use disorder, despite the fact that the facilities did not have adequate levels of appropriately trained staff to meet the needs of those residents. The AG’s Office also alleges that numerous overdoses have occurred at the Athena facilities, some of which the Athena facilities failed to report to DPH. According to the AG’s Office, Athena was aware that this conduct led to noncompliance with regulations but still encouraged the Athena facilities to admit residents with histories of SUD. The investigation by the AG’s Office also found that one of the facilities named in the settlement failed to adequately screen staff for COVID-19 infection, risking the spread of the virus to medically vulnerable residents.

Under the terms of the settlement agreement, in addition to the financial payment, Athena has also agreed to participate in a program with Alliant Health Solutions, which has received a grant from the U.S. Substance Abuse and Mental Health Services Administration to create “Centers of Excellence for Geriatric Emotional/Mental Health and Substance Use Education.” This program will result in updates to Athena’s policies, procedures, and trainings with respect to its treatment of residents with histories of SUD. Athena has also agreed to hire an auditor to review records every six months to assess this program, the results of which will be reported to the AG’s Office. Furthermore, under the terms of the settlement, Athena represents that it has adopted or is in the process of adopting a series of compliance initiatives, including mandatory compliance training, annual mock surveys, hiring of four full-time regional nurses dedicated to clinical operations and compliance, and implementation of a system-wide electronic dashboard. The AG’s Office also has authority, pursuant to this agreement, to require many of Athena’s facilities to contract with an independent compliance monitor if those facilities receive serious deficiencies in future surveys from DPH.

This matter was handled by Deputy Division Chief Kevin Lownds, Senior Trial Counsel Elisha Willis, Managing Attorney Gregory Matthews, Assistant Attorney General William Champlin IV, Senior Healthcare Fraud Investigator Heather Dwyer, Senior Healthcare Fraud Investigator Mirlinda Sejdiu, Senior Healthcare Fraud Investigator Erica Schlain, Senior Healthcare Fraud Investigator Christine Barker, and Nurse Investigator Barbara Edwards, all of the AG’s Medicaid Fraud Division. Deputy Chief Christina Chan of the AG’s False Claims Division also participated in the investigation of the allegations. The initial complaints were referred for investigation by the Massachusetts Department of Public Health and the Office of Long Term Care Ombudsman, both of which provided substantial assistance with the investigation. City and town officials from Marlborough, Northampton, and Worcester also provided substantial assistance with this investigation.

The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,542,963 for Federal fiscal year 2023. The remaining 25 percent, totaling $1,847,641 for FY 2023, is funded by the Commonwealth of Massachusetts.

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