BRISTOL, Tenn. (WJHL) — The federal government is halting payments to Viviant Healthcare in Bristol for failing to meet health and safety requirements, essentially forcing a shutdown that will leave dozens of families searching for a new long-term care facility for loved ones.
The move, effective Friday, comes after a months-long investigation by the Centers for Medicare and Medicaid Services (CMS). A survey completed June 29 found a “level of harm” that amounted to “immediate jeopardy to resident health or safety.”
The issues covered in a 22-page CMS complaint point to a facility whose ownership wasn’t paying vendors, including the medical company that provided on-site physicians, a dialysis company, a chemical vendor and even food vendors. Goldner Capital Management, owned by Samuel Goldner, is listed as having been Viviant’s primary owner since October 2020.
“The facility failed to maintain an adequate supply of emergency foods and honor monetary contractual agreements of vendor services (which) had the potential for disruption in essential services and created an Immediate Jeopardy,” the complaint reads.
It defines immediate jeopardy as noncompliance by a provider that “has caused or is likely to cause serious injury, harm, impairment or death to a resident,” noting that at the time the facility housed 55 residents.
The Tennessee Health Facilities Commission also investigated Viviant and suspended admissions in a July 12 order that also fined the nursing home $30,000.
Some of Goldner’s other nursing homes have also run into issues, including two Viviant branded nursing homes in Charleston, S.C., that were put into receivership earlier this year and are now being operated by another company.
A public notice from CMS dated Wednesday says that due to Viviant’s failure “to substantially comply” with federal health and safety participation requirements, “CMS will terminate the Medicare provider agreement between the Secretary of Health and Human Services” and Viviant. For patients who came to the facility before July 1, CMS will pay for another 30 days of services.
Aside from the disruption for families, that may be a very short window for finding a new location due to the current strain on nursing home capacity. Ballad Health CEO Alan Levine told News Channel 11 bed shortages — largely due to staffing shortages — have recently caused delays in moving hospital patients who are ready to step down to skilled nursing facilities like Viviant.
“I feel for the residents that trusted what they were promised,” Levine said. “I can’t comment on what happened because I don’t know the details but it’s going to be traumatic for them, and it’s traumatic for their families.
“I just hope there’s enough capacity in the region to accommodate the needs of these of these people.”
The public notice says CMS is “closely monitoring the relocation of residents to other facilities.”
Mounting bills bring the pressure
The CMS complaint includes dozens of emails that show staff, including the now-former administrator, attempted repeatedly to get the company to pay vendors before services were cut off.
“We … are not going to get a food truck if the bill is not paid,” the former administrator wrote in a June 5 email to the CEO, two hours after an email from the food vendor to the administrator saying the company wouldn’t accept any further orders until payment was made.
Just days before that, the administrator emailed an accounts payable rep to say the medical director — a contracted physician providing services at Viviant — would terminate services for non payment at the end of June.
“I have it in writing,” the email read. “If this does not get paid in full immediately. I recommend we start locating placement for our current resident population effective June 14, 2023. Effective July 1 at 12:00 AM we will not have a physician in this building, therefore we cannot provide care for our residents.”
The complaint reveals unpaid bills amounting to hundreds of thousands of dollars. The impacts range from dietary and housekeeping being unable to get dish detergent and laundry chemicals to the dialysis provider threatening to halt services over a $41,790.25 unpaid balance.
The narrative describes efforts to figure out where the buck stopped. The “portfolio CEO” said it was the responsibility of the accounts payable company, while an accounts payable employee was interviewed and said she’d worked in the role for more than a year “and vendor payment has always been an issue.”
She told CMS on June 23 that after the facility received a bill, it went to a second accounts payable person, then to an accounts payable supervisor, followed by a manager, an accounts payable issuer, “and then to the owner.”
“The facility’s AP#1 confirmed the final approval for vendors (sic) payments come from the owner,” the complaint reads.
CMS interviewed the owner by telephone June 25, who “stated he was unaware of any delinquent payment issues to vendors such as holds placed on food orders.
“The facility owner confirmed the Administrator contacts the Portfolio CEO and he (Portfolio CEO reports to the back office (AP Management company) and the buck stops there.”
A day later, the Portfolio CEO told the investigator “all payments have to be approved by the owner and accounts payable management company. The Portfolio CEO confirmed any payment plans must be approved by the Owner.”
By this time, the nursing home’s administrator had been terminated. The operations manager had been tabbed as his replacement June 12, but only served to June 14, when she resigned.
Private equity in nursing homes: ‘It’s a financial play for them’
The website for Goldner Capital Management says in its “about us” page that its management team “has worked tirelessly to establish themselves as a thought leader in the healthcare provider ecosystem both as owners and operators of various provider businesses around the United States.”
It describes a record over several years of “a consistent track record for establishing revenue-driving initiatives as well as cost management protocols in the portfolios it manages.”
Ballad’s Levine said private equity firms have “had an impact on health care, and some of that has not been good,” pointing to hospital-based physician groups “that are getting rolled up into private equity companies.”
On the long term care front, Levine said “there’s a major crisis brewing and there’s a lot of reasons for it.
“Number one is that so many of our elderly are covered by both Medicare and Medicaid, and the nursing home payment is not sufficient for it to be attractive to small providers.”
That’s left many of the traditional nursing home operators selling — as often as not to distant private equity groups. Goldner Capital, which owns Viviant and other nursing home operators, is out of New York and has three other Tennessee locations, in Chattanooga, Murfreesboro and Shelbyville.
The Goldner website includes the bold-lettered statement, “The core of our mission is to provide the highest quality of care to the patients we serve.”
Levine said that approach doesn’t represent the majority of his experience with private equity in healthcare.
“Private equity is entering the market and it’s not about longevity of care and that kind of thing,” Levine said. “I mean, it’s a financial play for them.”
News Channel 11 reached out to an email that was provided for Samuel Goldner requesting information on the situation and plans for helping find placement for residents, as well as the future for staff. That was unanswered.
Staff on site said they weren’t authorized to speak.