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Regulators have questions.\u00a0\u00a0\nBy MarketWatch\nPublished on: 2022-03-23T18:42:00Z\n\nThe nursing home mogul has quietly built a complex network of about 200 facilities in two dozen states that are often understaffed and in poor shape, regulatory data show.\n\nArticle Content:\n\nIn a bland brick office building across the street from a King Kullen supermarket in New York\u2019s Long Island, nursing home magnate Ephram \u201cMordy\u201d Lahasky is tallying up his latest deals. It\u2019s a Friday afternoon in early February, and Lahasky has recently picked up 17 facilities in Ohio, he says, a couple in Massachusetts, and has his eye on five more in the south. He scribbles notes about his facilities on his office whiteboard and sifts through the piles of paper covering his desk\u2014some of them chord sheets for songs he\u2019s rehearsing with his garage band. By mid-month, he expects to take over another seven or eight nursing homes in Pennsylvania.\nHis typical shopping list, Lahasky says, includes facilities that are bleeding cash or have lots of compliance problems\u2014or both. \u201cWe don\u2019t mind problems,\u201d he says. \u201cWe like problems.\u201d\nThe 56-year-old Lahasky, who has shaggy gray hair and a penchant for improv comedy and acoustic guitar, has seen his share of problems. Over the past decade, he has built a complex nursing-home network that involves about a dozen different operating companies and roughly 200 facilities in two dozen states, where he or his wife own some or all of the operations, the real estate, or both. MarketWatch combed through business and regulatory filings, property records, and data from the Centers for Medicare and Medicaid Services to identify Lahasky\u2019s holdings. Some of the nursing homes in his portfolio have been the subject of regulatory and law enforcement scrutiny,\u00a0 including Federal Bureau of Investigation raids on two facilities, a former administrator\u2019s indictment on charges of falsifying staffing records, and Department of Labor allegations of failure to pay overtime to nursing staff and other workers, records show. Lahasky and his wife have not personally been accused of wrongdoing in any of the regulatory or law-enforcement actions.\nLahasky\u2019s fast-growing nursing-home portfolio highlights the industry\u2019s drift toward more complicated, fragmented and less transparent ownership as chains that were previously public or controlled by major private equity firms are split up or sold off. Going into the pandemic, there were four publicly traded nursing-home chains. Lahasky, who has largely avoided reporters for years and declines to be photographed, scored one of his biggest deals last year when he acquired one of those chains, Diversicare Healthcare Services, which operates 61 nursing homes in eight states.\nSeparately, Genesis HealthCare, which was owned by private equity firms Formation Capital and JER Partners before a 2015 merger with a public company, delisted its stock last year as part of a restructuring that gave an ownership stake to an affiliate of a small outfit headed by New York nursing-home investor Joel Landau.\nThe latest deals are a new twist on a trend that emerged roughly 20 years ago, when major private equity firms started making big bets on nursing homes. But with Washington politicians criticizing their tactics and easy wins hard to come by, some private equity funds backed by institutional capital have retreated from the industry, and a new wave of smaller private investors, like Lahasky, now control some of the biggest nursing home operations. Private investors often use complex ownership structures and webs of related entities that pose challenges for regulators trying to keep tabs on nursing home owners and ensure quality care, researchers and resident advocates say. They add that the opacity often confounds residents and families seeking accountability for COVID catastrophes and policymakers assessing how much taxpayer money should go to nursing homes.\nThe nursing-home industry \u201cpromotes a narrative that they\u2019re underpaid,\u201d particularly by Medicaid, the government program that covers more than 60% of nursing-home residents, says David Stevenson, a health policy professor at Vanderbilt University School of Medicine. But it\u2019s hard to assess the merits of that argument, he says, given \u201cthe convoluted ownership structures where you can\u2019t track the flow of dollars.\u201d\nThe White House in late February announced a nursing-home reform package designed in part to make facility ownership more transparent, calling for a new federal database to track owners and operators across states, among other measures.\nLahasky does not maintain a corporate web site. Although federal data don\u2019t present the full picture of Lahasky\u2019s nursing-home affiliations, the 97 facilities for which CMS officially listed him as an owner as of February show a pattern of understaffing and subpar quality. Just two of the 97 facilities have the top overall five-star rating from CMS, compared with 23% of all nursing homes, while more than two-thirds of the facilities where Lahasky has an ownership stake have one- or two-star ratings, indicating lower quality. Only 3% of the Lahasky-owned facilities meet the federal government\u2019s recommended staffing level of 4.1 total nurse staffing hours per resident day, compared with more than a quarter of all nursing homes. Lahasky points out that many of his facilities are \u201cmajor turnarounds\u201d taken over from deeply distressed chains such as Skyline Healthcare, which collapsed in 2018.\nLahasky acquired many of his nursing homes in \u201cvery hairy deals,\u201d he says. \u201cIt can take two or three years to turn around a reputation.\u201d\nDriving along rainy streets of suburban Hewlett, N.Y., in an SUV emblazoned with the logo of an ambulance service\u2013one of his longtime side businesses\u2013Lahasky takes a detour around stalled traffic. He has just left his office, and his mind is on his lifetime of work. As a kid in Queens\u2019 Far Rockaway neighborhood, just a few minutes\u2019 drive away, he\u2019d go down to the beach\u2014not to splash in the surf, he says, but to sell sodas to parched beachgoers for 35 cents each.\nLong-term care of seniors wasn\u2019t Lahasky\u2019s first\u2014or second\u2014career. After studying math and computer science in college, he spent 20 years as a computer programmer with the Long Island Rail Road, he says, working on payroll and timekeeping systems\u2014skills that would later prove critical in his nursing home operations. Having driven a taxi during college, he launched his own transport company on the side. He started with a couple of vans taking kids to school and eventually expanded into ambulance services, a business that gave him connections in the nursing-home world. Along the way, Lahasky says, he spent years working on his improv comedy, studying with the comedy troupe Upright Citizens Brigade.\nLahasky first got into the nursing home business in 2012, he says, with the help of Benjamin Landa, then head of New York nursing home company SentosaCare. In a 2019 ruling in a class action lawsuit that did not involve Lahasky, a federal judge in Brooklyn found Landa and affiliated entities liable under human-trafficking law in connection with the recruitment of Filipino nurses working in nursing homes. Landa and the other defendants denied the allegations in court. The parties have asked for the court\u2019s approval of a $3 million settlement that also seeks to vacate the court\u2019s finding of liability under human-trafficking law.\n\u201cMaybe they did some wrong things, but it doesn\u2019t sound like such a terrible thing,\u201d Lahasky says. He and Landa remain co-owners of more than 20 facilities, according to federal data. \u201cHe helped me out. I\u2019m not going to leave him high and dry,\u201d Lahasky says of Landa. \u201cI kept doing deals with him\u2014to a point.\u201d The sticking point, he says, was not Landa\u2019s legal trouble but Lahasky\u2019s compensation. \u201cIf I\u2019m doing the work, I need to be compensated for doing the work,\u201d he says. Mark Weiss, a spokesman for Landa, said Landa is a \u201cpassive investor\u201d in the facilities co-owned with Lahasky and is looking to unwind such investments where he doesn\u2019t control facility management.\nIn his early years in the business, Lahasky invested in several facilities operated by Continuum Healthcare, including the Wanaque Center for Nursing and Rehabilitation in Haskell, N.J., which housed a pediatric unit. In 2018, while still under Continuum\u2019s management, 11 children died in an adenovirus outbreak at the facility, and state inspectors found \u201cegregious deficient practices in infection prevention and control.\u201d Lahasky says he was a less than 3% owner in the Wanaque real estate and had no involvement with the facility\u2019s operations. \u201cI was purely an investor,\u201d he says. A spokesperson for Continuum declined to comment on the outbreak and inspection findings but said that the Wanaque Center was acquired by another ownership group in 2019.\n\u201cThe nursing-home industry promotes a narrative that they\u2019re underpaid, particularly by Medicaid. But it\u2019s hard to assess the merits of that argument given the convoluted ownership structures where you can\u2019t track the flow of dollars.\u201d\nMeanwhile, payroll questions emerged at other Lahasky-affiliated facilities. The Department of Labor in 2018 filed suit against CHMS Group, a Lahasky-affiliated provider of payroll and other back-office services, and 14 Pennsylvania facilities co-owned by Lahasky, alleging a failure to compensate employees for all the overtime hours they worked. \u201cThere were definitely errors, and they\u2019ve been corrected,\u201d Lahasky says, although he disputes some of the Labor Department\u2019s allegations regarding pay for employees working through meal breaks. CHMS denied the allegations in court, saying employees were properly compensated, and the case is ongoing.\nIn 2019, Waterbury Gardens Nursing and Rehab, a Connecticut facility co-owned by Lahasky, entered a court-ordered receivership. The facility had insufficient funds for \u201cpayroll, food, medical supplies and other necessary expenses,\u201d the state Commissioner of Social Services said in a court filing. In the years leading up to the receivership, the facility had paid sharply increasing amounts of rent to a related party, according to cost reports filed with the state. In the year ended September 2018, the facility reported paying over $1.1 million in rent, up from $633,000 a year earlier, to Waterbury Gardens Holdings LLC, a Connecticut company where Lahasky is a principal, according to state business filings. Such related-party transactions are not illegal but are often criticized by resident advocates, who say they allow owners to vacuum money out of facilities that would be better spent on patient care and create the impression that facilities are struggling financially, bolstering operators\u2019 push for higher Medicaid reimbursement.\nAsked about the rent paid to the related party, Lahasky said, \u201cthat doesn\u2019t seem accurate to me,\u201d but declined to review the cost reports for accuracy. \u201cIf you own the real estate and the operations, you\u2019re allowed to charge yourself whatever you want in rent,\u201d he says. \u201cI never got a dollar from that facility,\u201d he says, adding that the nursing home\u2019s financial problems were due to issues with the Medicaid reimbursement rates.\nThe early private equity nursing home investors often focused on chains that owned most of their facilities, looking to unlock the value of the real estate, according to research co-authored by Stevenson, the Vanderbilt health policy professor. They\u2019d then separate the real estate from the nursing home operations, with the operator typically paying rent as well all the property-related expenses such as property taxes, an approach that also helped limit potential legal liabilities. In 2011, major nursing-home chain HCR ManorCare sold most of its real estate in a $6.1 billion deal that benefited its private equity owner, Carlyle \n        CG,\n        -1.01%.\n       Over time, HCR ManorCare could no longer afford the new rents associated with the facilities, and the company filed for bankruptcy in 2018. Carlyle, which manages $300 billion of institutional capital, hasn\u2019t owned any U.S. nursing homes since 2018. Some of the former ManorCare facilities, as well as some former Golden Living facilities previously owned by private equity, are now in Lahasky\u2019s portfolio.\nIt\u2019s now common for nursing homes, including those affiliated with Lahasky, to pay not only rent, but also management fees and other service fees to related entities. Following private equity buyouts, nursing homes\u2019 management fees and lease payments tended to increase sharply, according to a 2021 study by researchers at the University of Pennsylvania, New York University, and the University of Chicago, while cash on hand decreased. Going to a private equity owned nursing home raised the short-term risk of dying by 10% for Medicare patients, the study found, while raising taxpayer spending by 11%, compared with facilities not owned by private equity.\nLahasky says that when his facilities pay management fees to related parties, those services are typically provided at cost, although rent that his facilities pay to related parties is \u201ca profit center, absolutely.\u201d He likes to have stakes in both the operations and the property company, he says, and \u201cit\u2019s in my best interest that the facility perform well on both sides.\u201d\nAs Waterbury Gardens headed into receivership, Lahasky had his eye on Diversicare, the Brentwood, Tenn., based chain of 61 nursing homes. Through his company MED Healthcare Partners, Lahasky initially approached Diversicare about a deal in spring 2019, according to securities filings. The Diversicare board said it wasn\u2019t interested, according to the filings\u2014but the pandemic would change everything.\nThe pandemic was swift to strike Lahasky, personally and professionally. In March 2020, when New York hospitals were overrun, he had a severe case of COVID-19 and was nursed by his wife at home, with an IV running from his coat rack, he says.\nThe scene was far more chaotic in some facilities co-owned by Lahasky. By late May 2020, Brighton Rehabilitation and Wellness Center in Beaver, Penn., had 335 occupied beds, and 76 residents had died of COVID-19, at the time one of the country\u2019s deadliest nursing home outbreaks, according to CMS data. An inspection that month found that facility staff hadn\u2019t been adequately trained in infection control procedures.\nLahasky notes that the facility is one of the state\u2019s largest, and that some other large facilities had even more deaths.\nEven while he was sick with COVID, \u201che was on the phone constantly, yelling at everyone to wear masks and sourcing PPE,\u201d says his assistant, Ann Morhaime.\nBut the problems in Pennsylvania were just beginning. In August 2020, the state\u2019s attorney general said that Brighton Rehab was a subject of criminal investigations into nursing home neglect during the pandemic. A few weeks later, agents from the FBI and the Pennsylvania attorney general\u2019s office raided Brighton Rehab, as well as Mt Lebanon Rehabilitation and Wellness Center outside of Pittsburgh., another facility co-owned by Lahasky. The former administrator of Mt Lebanon was indicted in Feb. 2021 on charges of defrauding the government in connection with allegedly falsified staffing records at the facility. She pleaded not guilty.\nThe day after the indictment, the Pittsburgh Post-Gazette published an opinion piece by Lahasky that said the federal government was threatening people affiliated with Brighton Rehab with indictments \u201cif they do not offer evidence in support of the federal government\u2019s theory about what happened at Brighton.\u201d Lahasky also set to work investigating the Mt. Lebanon staffing situation himself, he says. While he found one employee who was getting paid for hours he didn\u2019t work, he says, he found no evidence that the former administrator had anything to do with it.\nAsked about Brighton Rehab and related investigations, the Pennsylvania attorney general\u2019s office said in mid March that the investigations are ongoing.\nAs the scrutiny was building in Pennsylvania, Lahasky and his partners were looking to buy a group of Genesis nursing homes in Vermont. In July 2020 emails to Vermont regulators obtained by MarketWatch through an open records request, the attorney who represented the purchasing group, Shireen Hart, initially identified Lahasky, along with Akiva Glatzer and David Gamzeh, co-owners of the Lahasky-affiliated operator Priority Healthcare Group, as the purchasers of the Genesis facilities. But when the purchase of the facilities\u2019 real estate was completed in October 2020, the month after the raids in Pennsylvania, it was Lahasky\u2019s wife Akiko Ike, rather than Lahasky himself, who was listed as co-owner. A local newspaper was first to report Lahasky\u2019s involvement in the Vermont deal. The new ownership group entered agreements to manage the facilities, even as Genesis affiliates retained the licenses to operate them. A few days later, the group filed an application with Vermont regulators to become the licensed operators. The new management changed the facilities\u2019 phone and computer systems and started operating the homes under new names\u2014without having licenses for the facilities, says Alice Harter, a Vermont long-term care ombudsman. \u201cIt\u2019s like putting the cart before the horse,\u201d she says.\nRegulators had trouble keeping up with who exactly was buying the facilities. In March 2021, an official with the Vermont Agency of Human Services, which oversees nursing home ownership changes in the state, asked Hart, the attorney, to clarify whether the third purchaser, in addition to Gamzeh and Glatzer, was Ike or Lahasky. The official noted that Ike had been identified as the third purchaser, but Lahasky\u2019s name was on the loan documents and other key places in the application. Hart told the official in a July 2021 email that the group was removing Ike from the application, leaving only Gamzeh and Glatzer as the prospective buyers. \u201cWe were willing to walk away,\u201d Lahasky says. \u201cWe didn\u2019t want to lose the deal for my partners.\u201d Ike did not respond to requests for comment.\n\u201cFor some reason, the state of Vermont looks at the application and says, \u2018Mordy Lahasky\u2019s involved. He\u2019s got all these problems in Pittsburgh,\u2019\u201d Lahasky says. \u201cAren\u2019t you innocent until proven guilty?\u201d He acknowledges that his name was on the loan documents. \u201cThe bank wanted my guarantee. I gave them a guarantee. So what?\u201d he says.\nBut Lahasky\u2019s problems went far beyond Pittsburgh. In June 2021, he was named as a defendant in a lawsuit filed by the Service Employees Pension Fund of Upstate New York against the Pearl Nursing Center of Rochester, alleging that the nursing home operator and Lahasky had failed to make correct and timely contributions to the pension fund. Pearl and Lahasky replied in court that they\u2019d already made a contribution to cover most of 2020 and had made monthly contributions from January 2021 forward. The case settled late last year after Pearl made additional contributions related to covered employment, interest and attorneys\u2019 fees.\nThe pension fund \u201cdoesn\u2019t set aside resources to litigate month after month with a recalcitrant employer,\u201d says Daniel Kornfeld, an attorney representing the fund. It was \u201cunusual and very discouraging,\u201d he says, that the employer took so long to live up to its obligations.\n\u201cI was never technically the operator of the home,\u201d Lahasky says, although he did invest in the real estate. \u201cI was involved,\u201d he adds, \u201ctrying to keep them from falling apart.\u201d As for the pension contribution issue, he says, \u201cI believe it\u2019s been fixed.\u201d\nThe pension fight is part of a broader effort to ensure workers are correctly compensated, according to workers and officials at 1199SEIU United Healthcare Workers East, a union representing staff at Pearl as well as Comprehensive Rehab and Nursing Center at Williamsville, which is co-owned by Lahasky. Eight months pregnant, Tania Green worked over the Christmas and New Year holidays at the Williamsville facility to earn a little extra cash, she says, but she didn\u2019t get all the holiday pay she was owed. \u201cI\u2019ve got kids, and I don\u2019t want to work every holiday,\u201d says Green, 30, a nursing assistant. But \u201cbills have to be paid, and I\u2019d expect them to give me the time and a half.\u201d\n\u201cWhen it comes to holiday pay in our contract, or any type of pay that our members are due, I\u2019m forced to file grievances, go have meetings, and it may take more than one meeting just to get people\u2019s pay right,\u201d says Darlene Gates, an 1199SEIU organizer.\n\u201cI\u2019m not familiar with that,\u201d Lahasky says, when asked about the union\u2019s concerns, adding that he\u2019s \u201cnot made aware of every grievance.\u201d\nBy early 2021, Diversicare\u2019s board had reflected on the nurshing home chain\u2019s potential COVID-related liabilities, reimbursement rates and regulatory issues and decided to reexamine a potential deal, according to securities filings. In November, a Lahasky vehicle acquired the company in a $70 million leveraged buyout backed by Canadian bank CIBC. Lahasky says his investor group contributed $40 million in equity to the deal. Although the FBI raids had \u201cfreaked out my banks,\u201d Lahasky says, the bankers at CIBC \u201cknow me and know this is nonsense.\u201d CIBC declined to comment.\nIn contrast to the scrutiny in Vermont, nursing-home regulators in the eight states involved with the Diversicare deal generally didn\u2019t give Lahasky a hard time, he says. In Missouri, which is home to three Diversicare facilities, the Department of Health and Senior Services wasn\u2019t aware of the Diversicare acquisition before receiving questions from MarketWatch, says agency spokesperson Lisa Cox. The department was working with Diversicare in January for submission of documents needed to update the licensure records, Cox said. Some states didn\u2019t require advance notice because the licensed entities directly operating the nursing homes didn\u2019t change. Diversicare said in a statement that \u201cnotice was provided in advance of the transaction in all states that required notice\u201d and that it continues to communicate with regulators to ensure filings \u201care completed to the regulators\u2019 full satisfaction.\u201d\nIn Maryland, Lahasky\u2019s interest in a single facility unrelated to Diversicare triggered more scrutiny from regulators. Late last year, Lahasky, his wife and other investors were involved in the purchase of North Oaks, a continuing care retirement community in Pikesville, Md. In reviewing the transaction, the Maryland Health Care Commission noted the indictment of the former Pennsylvania nursing home administrator and that 10 out-of-state facilities owned in part by Lahasky had been flagged by CMS for having recent incidents of abuse or neglect cited in inspection reports or had a \u201cspecial focus facility\u201d designation, meaning they have several years\u2019 worth of serious quality issues.\nBut ultimately, there was little regulators could do, says Ben Steffen, executive director of the Maryland Health Care Commission. Under state law, he says, \u201cour ability to not approve an acquisition based on poor performance is very, very limited.\u201d The Commission has more power, he says, when buyers are looking to open a new nursing home or expand an existing one. In a December letter Steffen wrote to the North Oaks buyers, he said that they \u201cwould be likely to fail to meet the Quality Rating standard\u201d required to establish or expand a nursing home in the state. In the case of the Pikesville, Md. facility, Lahasky says,\u00a0 \u201caccording to the regulations, there was no reason to deny the application, and they did the right thing and didn\u2019t make anything up.\u201d\n\u2018They don\u2019t have blankets and pillows for people\u2019\nA few days before Christmas, a Burlington, Vermont nursing home resident sat in a wheelchair, covered in feces. \u201cI asked over an hour ago for someone to come in and help me,\u201d the resident told a state inspector, according to the inspection report. \u201cThis is my life, every day, and they don\u2019t seem to care. I sit like this for hours until someone decides I am deserving of their help.\u201d\nWhen the inspector asked the resident\u2019s assigned nurse to come see the resident, the nurse put out his or her arms and said, \u201cWhat? Do you want me to go clean [the resident] up now?\u201d according to the report. After the inspector spoke with the director of nursing, staff started cleaning up the resident 90 minutes after the inspector first noticed the resident\u2019s condition, according to the report.\nThe resident was on a hunger strike, aiming to bring awareness to conditions at the facility, according to the report. \u201cI worry about those that can\u2019t speak for themselves,\u201d the resident told the inspector.\nThe resident lives in a facility known as Queen City Nursing and Rehabilitation. So far as state and federal regulators are concerned, Queen City doesn\u2019t exist\u2014it\u2019s just a moniker given to the facility by the Lahasky-affiliated group that started managing the nursing home in late 2020 but never had a license to operate it. In December 2021, the group withdrew its application for the licenses for that facility, officially known as Burlington Health and Rehab, and four other facilities officially licensed to Genesis.\nAsked about the details in the inspection report, Lahasky said, \u201cthat building has been a problem for a long time.\u201d The application had to be withdrawn because if it wasn\u2019t, it would have been denied, he says.\nGamzeh and Glatzer, co-owners of the group that started managing the facility in late 2020, said in a statement provided by Hart, their Vermont attorney, \u201cwe are focusing on the future and continuing to work collaboratively with Genesis to resolve the future of the Vermont facilities as expediently as possible.\u201d Genesis spokesperson Lori Mayer said the care and safety of residents at the five facilities \u201cremains our number one priority,\u201d and that the licensed Genesis affiliates \u201care working to ensure that the centers are in compliance with state and federal regulations.\u201d\nOn a Sunday in January, when Jodi Gill visited her father at Brighton Rehab in Pennsylvania, conditions there were still unbearable, she says. \u201cThey don\u2019t have blankets and pillows for people,\u201d says Gill, who is among a group of residents and family members suing Brighton over its handling of the pandemic. In court filings, Brighton has said it used testing, screening, protective gear and other measures to fight the virus and claimed immunity from the claims in the lawsuit under the federal Public Readiness and Emergency Preparedness Act. \u201cI\u2019m not asking for the world,\u201d says Gill, who moved her father to another facility in February. \u201cI\u2019m asking for basics. I want to know my dad is warm.\u201d\n\u201cThere\u2019s budgets. Every facility has to control its usage. Otherwise things are through the roof,\u201d Lahasky says. \u201cIt\u2019s not like they don\u2019t have blankets in nursing homes.\u201d\n\u201cAll you hear about is the bad stuff,\u201d he says a moment later. \u201cNobody hears about the average facility\u2014you go in, and the facility\u2019s clean and the patients look good and they\u2019re getting what they need,\u201d he says. \u201cI don\u2019t know why we get beat up as bad as we do.\u201d\nYour $2 bills could be worth over $20,000 \u2014 here\u2019s 3 ways to check\nEleanor Laise is a healthcare reporter for MarketWatch and is based in Washington.\nEleanor Laise is a healthcare reporter for MarketWatch and is based in Washington.\n\nSource: MarketWatch\n", "timestamp_ms": 1648060920000, "published_utc": "2022-03-23T18:42:00Z", "article_url": "https://www.marketwatch.com/story/all-you-hear-about-is-the-bad-stuff-ephram-lahasky-has-a-new-investment-model-for-americas-nursing-homes-regulators-have-questions-11648041864", 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\ No newline at end of file