Attorney General Bonta Conditionally Approves Sale of California Nevada Methodist Homes to Pacifica Companies LLC

 California Attorney General Rob Bonta today conditionally approved the sale of California Nevada Methodist Homes (CNMH), a nonprofit that owns and operates two continuing care retirement communities in California. The conditional approval would allow the retirement communities in Oakland, Alameda County, and Pacific Grove, Monterey County, to come under the ownership of Pacifica Companies LLC (Pacifica). Under California law, any transaction involving the sale or transfer of control of a healthcare facility owned by a nonprofit must secure the approval of the state Attorney General. The conditions Attorney General Bonta approved today ensure access to quality healthcare and will allow current residents to continue receiving care at the facilities while protecting their outstanding entrance fee obligations.

“Our primary responsibility when reviewing healthcare transactions is to protect the people. With our conditional approval today, we ensured that the residents of these retirement communities continue to receive the best possible care and quality of life,” said Attorney General Bonta. “Due to the strong conditions we’ve imposed on the sale of these continuing care retirement communities, the individuals and families living in Oakland and Pacific Grove can remain in the communities they called home and receive uninterrupted health care.”

The two continuing care retirement communities (CCRCs) are Lake Park, which is located in Oakland and includes a 35 licensed-bed skilled nursing facility (SNF), and Forest Hill, which is located in Pacific Grove in Monterey County and includes a 26 licensed-bed SNF. Both facilities also include a Residential Care Facility for the Elderly (RCFE). The proposed $34 million sale is part of CNMH’s chapter 11 bankruptcy proceeding filed March 16, 2021. The Bankruptcy Court has already approved the proposed sale to Pacifica pursuant to an order entered on February 8, 2022. 

The expert report identified safety issues at other Pacifica facilities. Between 2017 and 2022, Pacifica’s rate of citations was significantly higher than the average rate for all RCFEs in California. The most troubled Pacifica facilities were in Oakland, Oxnard, and Modesto.

Therefore, as part of his conditional approval, Attorney General Bonta has imposed specific conditions for the sale which would require Pacifica to, among other things:

  • Appoint a monitor to ensure resident safety;
  • Report semi-annually on safety; 
  • Preserve access to skilled nursing facility services for the community;
  • Consult with a Community Advisory Board on a quarterly basis; 
  • Pay off debt, including existing bond debt and existing lines of credit;
  • Honor residents’ contracts; and 
  • Ensure that outstanding entrance fee obligations to current residents are paid.

The California Department of Justice’s Healthcare Rights and Access Section (HRA) works proactively to increase and protect the affordability, accessibility, and quality of healthcare in California. HRA’s attorneys monitor and contribute to various areas of the Attorney General’s healthcare work, including nonprofit healthcare transactions; consumer rights; anticompetitive consolidation in the healthcare market; anticompetitive drug pricing; privacy issues; civil rights, such as reproductive rights and LGBTQ healthcare-related rights; and public health work on tobacco, e-cigarettes, and other products.

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2022 NAAG/NASCO Annual
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Cosponsored by National Association of State Charity Officials October 12-14, 2022 History Colorado Center Denver, CO  Virtual Option Also Available REGISTER TODAY The 2022 NAAG/NASCO Charities Conference will take place in Denver, Colorado from October 12-14, 2022. The conference is the only annual event at which charity regulators and nonprofit organizations and their attorneys, accountants, fundraisers, and advisers can meet, learn about, and discuss issues of interest to the charitable sector. The conference will provide an opportunity to hear from regulators and others in the nonprofit sector on current issues, including sessions on Establishing an Effective and Healthy Board Culture in a Stress-Filled World and Challenges and Changes in Charitable Fundraising. Internationally-noted scholar Professor Una Osili, of the Indiana University Lilly Family School of Philanthropy, will provide the keynote address on Trends in the Philanthropic and Charitable Sectors and their Implications – What the Numbers Tell Us. Attendees will also hear from top state officials on regulatory priorities. The sessions on Wednesday, October 12 are open to the public, starting at approximately 8 a.m. and ending with a networking reception that evening. Sessions on October 13-14 are open to government staff only with the government portion of the conference ending at 11 a.m. on Friday, October 14.   Click here to view the public agenda. We plan to keep the conference webpage updated with the most current version. Registration Prices (in-person attendance):  Attorneys General of NAAG Member Offices: Complimentary Government Staff: $500 General Admission: $500  The registration deadline is Friday, September 30, 2022. A $100 late fee will be assessed to late registrants. Additional information regarding pricing can be found here.  This conference will also be offered virtually for government staff from October 12-14, and for general admission on October 12. Below is the registration cost for the virtual option.   Registration Prices (virtual attendance): Attorneys General of NAAG Member Offices: complimentary  Staff of Attorney General NAAG Member Offices and Staff of Non-AGO NASCO Members: complimentary  Other Government and General Admission: $200 NAAG will apply for CLE for eligible attendees per CLE accrediting body guidelines. ROOM BLOCK NAAG has secured a room block at The Art Hotel. The group rate is $259.00 per night plus tax. This rate will be available until Tuesday, September 20, 2022, or until the block is full, whichever comes first. There are several other hotels close to the History Colorado Center that you may wish to consider, including but not limited to: The Slate DenverHampton Inn & Suites – Convention Center, Hyatt Place Denver, Downtown, and Homewood Suites – Convention Center. These, and other hotels in the area, may offer government rates. Please email Amy Jackson at ajackson@naag.org with any questions. REGISTER TODAY If you have created your NAAG account and do not see the correct pricing listed, please make sure you have entered your organization under your profile. Attorney general staff will need to wait until after your account is verified by your office before being able to register for this event. The 2022 NAAG/NASCO Annual Charities Conference is coordinated by the National Association of State Charity Officials and the NAGTRI Center for Consumer Protection, whose mission is to assist and enable state and territory attorneys general in protecting the public in the areas of consumer protection and charitable asset and entity oversight by providing information, technical assistance, and support; facilitating cooperation among attorney general staff through open dialogue and advanced communication systems; planning, organizing, and conducting training and seminars for the exchange of ideas and information on relevant matters; and promoting the development of effective programs and education for the protection of the public. Please check out the Center’s consumer-facing website at ConsumerResources.org.
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Attorney General Ellison shuts down mismanaged school-supply charity, secures permanent ban against president

Minnesota Attorney General Keith Ellison announced today that his Office has shut down Welch Charities, a Minnesota nonprofit, and has permanently banned its president, Arturo Eguia, from operating a charity, having access to charitable assets, or soliciting charitable contributions in Minnesota. The charity, whose stated mission is to help children start the school year right, operates the annual Indian Bike Week motorcycle festival and fundraising event. The civil enforcement action, filed today in Ramsey County District Court, arises from failures in oversight by the organization’s board of directors that Eguia led, that resulted in the misuse of tens of thousands of dollars in charitable assets.   

Under the terms of the enforcement action, the charity must liquidate its assets, distribute them to another nonprofit organization with similar charitable purposes, and dissolve. In addition to a permanent charitable ban, Eguia is also subject to a penalty of $50,000 if he violates the terms of his settlement.   

“As Minnesota’s chief regulator of charities and protector of consumers, it’s my job to ensure nonprofits that raise money for charitable purposes use it as they promised their donors they would use it. Arturo Eguia took advantage of Minnesotans’ and motorcycle riders’ trust and generosity. Instead of using donations well-intentioned people made to Welch Charities to help low-income school children, Eguia instead used the money intended for children to enrich himself, travel on the charity’s dime, and prop up his for-profit business,” said Attorney General Ellison. “This settlement ensures the money the charity raised will actually be used to help low-income children — and that Eguia can never do anything like this again.” 

Attorney General’s investigation 

The Attorney General’s Office’s Charities Division launched this investigation under Minnesota’s civil nonprofit corporation and charitable trust laws, which require nonprofit directors and those who hold charitable assets to adhere to strict governance standards and fiduciary duties. The Attorney General’s Office’s investigation revealed that the charity’s board of directors never met, discussed, voted, or kept minutes on any operational decisions, allowing Eguia to run the organization without any input, supervision, or regard to Minnesota laws. The settlement agreement also alleges that the charity failed to properly manage and oversee its charitable assets: since at least August 2017, the charity failed to track its revenue, expenditures, or deposits; retain receipts of transactions; maintain a ledger; prepare financial statements; or otherwise keep accurate financial records.  

These failures to properly manage and oversee Eguia and the charity’s assets enabled tens of thousands of dollars of those assets to be misused. Despite the charity raising more than $142,000 over a four-year period, it only distributed $12,203 of these funds for charitable purposes. At the same time, Eguia’s personal spending and unchecked cash withdrawals tallied at least $36,856, including expenditures for restaurants and bars, hotels, auto parts, car washes, pest control, and custom motorcycle products.  

During its investigation, the Attorney General’s Office discovered that the charity’s inadequate record-keeping and internal controls made the amount of misuse difficult, if not impossible, to fully quantify. 

In Minnesota, the Attorney General has civil enforcement authority over the state’s nonprofit corporation and charitable trust laws. As in all cases involving potential misuse of charitable assets, the Attorney General’s Office will evaluate if there is sufficient evidence to make a referral to the appropriate authorities for criminal law enforcement. 

Under state law, nonprofit executives owe fiduciary duties to act in the best interests of the charities that they serve, including putting the interests of the nonprofit above any personal financial interests. The Attorney General’s Office provides additional information about these fiduciary duties, as well as other resources to help nonprofit leaders properly serve their organizations, on its website at www.ag.state.mn.us/Charity/InfoNonProfits.asp

Attorney General James Secures $850,000 from Disability Services Not-for-Profit That Defrauded Medicaid

Maranatha Human Services Cheated Medicaid By Illegally Paying CEO
and Family Members for Work That Was Not Medicaid Eligible

New York Attorney General Letitia James today announced a settlement with Maranatha Human Services, Inc. (Maranatha), a not-for-profit organization that provides Medicaid services to people with developmental disabilities in New York. The agreement resolves claims brought by the state and federal government in a qui tam action initiated by a former employee against Maranatha and Henry A. Coley, the organization’s former chief executive officer. Maranatha committed Medicaid fraud, violating the New York False Claims Act by knowingly submitting false reports of its costs to the New York State Department of Health (DOH), falsely claiming reimbursement for millions of dollars Maranatha spent on salaries and contractor fees. These funds were used to enrich Coley, his family and friends, and to support side businesses he controlled — not for the provision of Medicaid services.

“As a charitable organization and Medicaid Provider, Maranatha was entrusted with public funds to serve a particularly vulnerable population,” said Attorney General James. “Instead, Maranatha diverted these critical funds to benefit its chief executive officer, his family and friends. Self-dealing will not go unchecked in New York. My office is committed to holding Medicaid providers accountable, ensuring the welfare and well-being of all New Yorkers, and protecting the integrity of this critical program.”

As part of the settlement, Maranatha has agreed to cooperate with the New York State Office for People with Developmental Disabilities (OPWDD) and take all necessary steps to transition the operations of its Medicaid-funded programs to one or more other providers to ensure continuity of services. Maranatha has agreed not to submit new claims for payment to state-funded health care programs on or after June 30, 2023. Within 60 days of the submission of the final claim to state or federal health care programs, Maranatha will submit its petition for dissolution under the New York Not-for-Profit Law to the Office of the Attorney General’s (OAG) Charities Bureau.

The federal government has also entered into an agreement with Maranatha to resolve its fraud claims stemming from the same misconduct. Maranatha will pay $510,000 to New York state and $340,000 to the federal government, for a total recovery of $850,000.

The state intervened in the whistleblower suit against Coley and Maranatha in February 2021. In its complaint-in-intervention filed against the defendants in April 2022, the state alleged that Maranatha paid excessive salaries and consulting fees to Coley and his family and friends, often in exchange for little or no work. The state also found that Maranatha paid independent contractors and Maranatha’s employees to work on side projects that had nothing to do with Maranatha’s provision of Medicaid services. Maranatha claimed such expenses as allowable costs in its Consolidated Fiscal Reports (CFRs) — costs that are reasonable and necessary for the provision of Medicaid services — when they were not. Because the state reimburses Maranatha at provider-specific rates set based on the legitimate Medicaid expenses reported in Maranatha’s CFRs, the state paid Maranatha at artificially inflated rates for each unit of service for which Maranatha billed the state. As a result, the state paid Maranatha millions above what it deserved from 2010 to 2019. 

In the settlement agreement, Maranatha admitted, acknowledged, and accepted responsibility for the following conduct:

  • Maranatha knew that it was required to distinguish “allowable costs” from “non-allowable costs” in its CFRs.
  • Maranatha knew that the allowable costs Maranatha reports in its CFRs are used by DOH, in part, to determine Maranatha’s reimbursement rates for the provision of Medicaid-funded services.
  • In each CFR that Maranatha submitted since 2010, Coley certified that Maranatha’s CFRs were true and correct, Maranatha accurately reported all expenditures made for services performed in accordance with the Mental Hygiene Law, and, since 2018, that Maranatha reported and adjusted out all non-allowable expenses on its CFRs.
  • From 2010 to 2019, Maranatha submitted annual CFRs that reported as “allowable costs” amounts expended not for Maranatha’s provision of Medicaid-funded services but instead to pursue certain for-profit business ventures, including a home goods business operated by Coley (non-Medicaid ventures).
  • Coley briefed Maranatha’s board of directors, which approved of Maranatha funding these non-Medicaid ventures.
  • Coley made a presentation to Maranatha’s board of directors acknowledging that it “was always the plan for Maranatha to use government funds as a launching pad to create private enterprise…”
  • Maranatha paid contractors to perform work related to the non-Medicaid ventures, including, since 2010, more than $300,000 to Coley’s daughter. Though much of her time was spent on work related to these non-Medicaid ventures, Maranatha reported her full compensation as an “allowable cost” in the CFRs.
  • Since 2010, Maranatha paid Coley more than $2 million in salary and benefits, and Maranatha claimed the full amount of that compensation as “allowable” costs on its CFRs. However, Coley devoted much of his time to working on non-Medicaid ventures.

The state previously resolved its fraud claims against Coley in a settlement that was approved by U.S. District Judge Kenneth M. Karas on November 9, 2021. Coley agreed to pay the State $132,000 and the federal government $88,000, representing the maximum restitution that he could afford to pay, and admitted and accepted responsibility for conduct alleged by the State and federal government in their complaints. Coley resigned from Maranatha during the state’s investigation in July 2021. As a result of his misconduct, Coley is barred from working or volunteering for any entity that receives funds from Medicaid. Additionally, Coley is permanently barred from serving as an officer, director, or trustee of any not-for-profit corporation in New York, and is similarly barred from serving in any capacity that permits him discretionary authority over charitable assets. 

The investigation was conducted by Attorney General James’s Medicaid Fraud Control Unit (MFCU) in consultation with the Charities Bureau. It was commenced after a whistleblower filed a complaint under the qui tam provisions of the New York False Claims Act, as well as the federal False Claims Act, in the United States District Court for the Southern District of New York. The New York False Claims Act allows individuals to file actions on behalf of the government and share in any recovery.

New York MFCU’s total funding for federal fiscal year (FY) 2022 is $59,918,216. Of that total, 75 percent, or $44,938,664, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $14,979,552 for FY 2022, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.

Attorney General James thanks the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of New York for its collaboration in the investigation, litigation, and resolution of this matter. 

The matter was handled by Principal Auditor-Investigator Theresa A. White, Auditor-Investigator Khristian Diaz, and Special Assistant Attorney General Ting Ting Tam of MFCU’s Civil Enforcement Division, which is led by Chief Alee N. Scott. Stacey Millis is the Chief Auditor of the Civil Enforcement Division. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney, and is a part of the Division for Criminal Justice. The Division for Criminal Justice is led by Chief Deputy Attorney General José Maldonado, and is overseen by First Deputy Attorney General Jennifer Levy.

Attorney General Ellison protects Minnesotans from unfair billing and collections with extension of Hospital Agreement

Minnesota Attorney General Keith Ellison announced today that his Office has negotiated an extension to the regulatory agreement that the Attorney General’s Office holds with all nonprofit hospitals in Minnesota, referred to as the “Hospital Agreement.” The Agreement provides important protections to Minnesotans who receive healthcare services at Minnesota’s hospitals by protecting patients from abusive, harassing, and deceptive practices when hospitals seek to collect medical debt. The Agreement also provides discounts on healthcare services for certain patients and prohibits unfair practices in billing and collections.  

The Agreement covers all 128 nonprofit hospitals in Minnesota — and for the first time, covers one of Minnesota’s two for-profit hospital systems, PrairieCare. The Hospital Agreement, which has been filed in Ramsey County District Court, is effective for a five-year term that expires on July 1, 2027. 

“It’s my job to keep Minnesotans safe from abusive billing and debt collection that can rob them of dignity and respect. That’s all the more important at a time of rising inflation and skyrocketing medical bills that make it tough to afford your life,” Attorney General Ellison said. “The Hospital Agreement is now a tradition of the Attorney General’s Office that Minnesotans count on to protect them from abusive medical billing and debt collection and help them afford their lives. As long as I’m attorney general, I will keep enforcing it.” 

Under the Agreement, hospitals must abide by their obligations as charitable organizations to meet certain standards of conduct imposed by their charitable missions. The Agreement requires hospitals to develop policies for assessing patients’ ability to pay, and to provide free healthcare, known as “charity care,” to qualifying patients. The Agreement also requires each hospital’s board of directors to take an active role in managing their facilities’ billing and debt collection practices. For example, the hospitals’ boards are required to adopt “[a] zero tolerance policy for abusive, harassing, oppressive, false, deceptive, or misleading language” when “collecting medical debt from patients.” Hospitals must also offer patients reasonable payment plans that treat them fairly “taking into account each individual’s ability to contribute to the cost of his or her care[.]”  

In addition to the protections listed above, the Hospital Agreement also affords patients many other protections, including:  

  • Hospitals must not charge uninsured patients more than they charged their “most favored insurer” for treatment and “shall apply the same percentage discount . . . for insured treatment that [they] would apply to charges incurred by a policyholder of its most favored insurer.” 
  • Hospitals must require the debt collection agencies with whom they contract to follow the provisions of the Hospital Agreement and cannot give their debt collectors blanket authority to take legal action against patients to collect medical debt. 
  • Hospitals must offer a reasonable payment plan to patients who are unable to pay the full amount of their bill before pursuing the debt in litigation, garnishing patient wages, or referring debt to a collection agency. Hospitals may not refer debt to a collection agency if the patient makes payments in accordance with the terms of the payment plan that the hospital agreed to.   
  • Neither hospitals nor their debt collection agencies may report patients to credit reporting agencies for failing to pay a medical bill. 

Recent enforcement action under Hospital Agreement 

In October 2020, Attorney General Ellison reached a settlement agreement with Hutchinson Hospital under the terms of the Hospital Agreement. The settlement required Hutchinson Hospital to restore more favorable hospital billing terms that it had unilaterally terminated for many of its patients, which had the effect of increasing their monthly medical bills beyond what patients agreed to pay. In June 2021, Attorney General Ellison announced that per the terms of the settlement agreement, Hutchinson Hospital had forgiven $184,000 of patients’ medical debt and had allowed certain patients to receive a 40% discount on outstanding medical bills. 

The Minnesota Attorney General’s Office instituted the Hospital Agreement in 2005 following a compliance review of a Minnesota healthcare provider that revealed numerous problems with hospitals’ collection activities, billing practices for uninsured patients, and the administration of charity care. The Attorney General’s Office and Minnesota’s non-profit hospitals subsequently renewed the Hospital Agreement in 2007, 2012, and 2017, each time for an additional five years.  

Dedicated email address for reporting concerns with medical billing or debt collection 

If you think you have been the victim of unfair or unreasonable medical billing or debt collection practices, please contact the Attorney General’s Office at hospital.billing@ag.state.mn.us, a dedicated email address that the renewed Agreement has established for the first time through which Minnesotans may report their issues or concerns with hospital billing. You may also submit an online complaint form on the Attorney General’s website at www.ag.state.mn.us/Office/Complaint.asp. In addition, you may call the Attorney General’s Office at (651) 296-3353 (Metro area) or (800) 657-3787 (Greater Minnesota), or write the office at 445 Minnesota Street, Suite 1400, Saint Paul MN 55101. 

Minnesotans may also learn more about their rights through two publications available on the Attorney General’s website: Medical Billing Pointers and Debt Collection Fact Sheet