MISSOULA, Mont. —

A federal jury ruled Wednesday that a health clinic in a Montana town where hundreds of people have died from asbestos exposure submitted 337 false asbestos claims that made patients eligible for Medicare and other benefits they shouldn't have received.

The seven-person jury said that the fraudulent claims caused more than $1 million in damage to the government.

The case focused on the Center for Asbestos Related Disease in Libby, Montana. BNSF Railway filed a lawsuit against the clinic under the federal False Claims Act in 2019.

The railroad company owned by billionaire Warren Buffett is also a defendant in numerous lawsuits over its own role in the town's contamination. In 2020, Montana's Supreme Court found BNSF liable for shipping asbestos-tainted vermiculite from a nearby mine through Libby.

The clinic and its high-profile doctor, Brad Black, have been at the forefront of efforts to help residents of the town, which came to national prominence when it was declared a deadly Superfund site two decades ago.

The jury's finding leaves the clinic subject to additional penalties. Under the False Claims Act, the railway could be eligible for 15% to 25% of any amount recovered by the government.

CARD and its attorneys had denied it made false medical claims on behalf of patients, arguing its diagnoses were in line with requirements of the 2010 Affordable Care Act, which included special provisions for the Libby victims.

"CARD was doing exactly what the law said," clinic attorney Tim Bechtold said earlier Wednesday during closing arguments that followed 11 days of testimony.

BNSF's lawsuit alleged CARD submitted more than 300 false claims on behalf of patients without getting outside confirmation that they had asbestos-related disease. The company also said 1,369 people received federal benefits with no disease diagnosis.

Dr. Black and the CARD clinic have certified more than 3,400 people with asbestos-related diseases, according to court documents.

Asbestos-related diseases can range from a thickening of a person's lung cavity, hampering breathing, to deadly cancer. Under the 2009 federal health law, victims of asbestos exposure in the Libby area are eligible for taxpayer-funded services including Medicare, housekeeping, travel to medical appointments and disability benefits for those who can't work.

Dr. Black is a pediatrician by specialty and has served as the Lincoln County Health Officer. He has previously said the ailments caused by the type of asbestos found in Libby are difficult to detect and can be missed by outside radiologists.

BNSF attorney Adam Duerk criticized Black's stated ability to perceive early signs of asbestosis disease that others missed.

"That's not the practice of medicine, that's the practice of roulette," Duerk said. "When you see it, when you're certain it's there, that's when you diagnose, not before."

Former Democratic U.S. Sen. Max Baucus, of Montana, helped craft the Libby provision in the health law. He said in depositions with attorneys that the clinic's practice of declaring some patients eligible for benefits without confirmation of their condition from a secondary source such as an X-ray was legitimate.

However, U.S. District Judge Dana Christensen barred Baucus's statements from the trial, saying it was the court's role to decide whether the law was followed.

At least 400 people have been killed by asbestos-related disease in the Libby area, according to health officials. Because of the long latency period for those diseases, symptoms can take decades to develop.

The tainted vermiculite came from a mine owned by the Maryland-based chemical company W.R. Grace. It polluted the Libby area over decades, including at a BNSF railway yard in the heart of the town of about 3,000 people.

Cleanup work began in 2000 after media reports of widespread health problems spurred a federal investigation. The EPA years later declared the agency's first public health emergency in the town. More than $600 million was spent to remove vermiculite from thousands of properties in Libby and surrounding communities.

Scientists say exposure to even a minuscule amount of asbestos can cause lung problems.

The case was sealed under court order for two years until the U.S. attorney's office of Montana declined to intervene. Officials have not given a reason.

Asbestos-tainted vermiculite was used as construction material in Libby and it remains inside many houses, where it was used as insulation. It was also shipped across the country by BNSF and installed in millions of homes.

Lawsuits against companies and officials over the contamination in Libby have resulted in large settlements and awards for victims.

More than 2,000 Montana residents reached settlements with the state totaling $68 million for failing to warn them about the dangers of asbestos exposure. In February 2022, a jury awarded an Oregon man $36.5 million in a lawsuit against W.R. Grace's insurer.

Is Medicare replacing its paper cards with new plastic cards? The short answer is no. Medicare is not replacing your paper card with a plastic chip card.

Scammers tried this con a few years ago. They've apparently fired it up again, as a lot of viewers are telling sister station WGAL about getting this call.

Back in 2018, Medicare sent beneficiaries new cards that were designed to better protect against identity theft.

Social Security numbers were removed from the old cards and replaced with a random combination of letters and numbers.

That switchover took nearly a year to complete and gave scammers an opportunity to rip people off.

Once that was done, scammers moved on to trying to convince victims that Medicare is switching from paper cards to plastic cards with chips. Again, that's not happening.

Of course, this is all designed to con victims into revealing their Medicare number, which can lead to identity theft and insurance fraud.

If you get any suspicious calls from someone claiming to be with Medicare, hang up and call the Medicare phone number on your card with any questions.

The pandemic has made staffing at nursing homes even more challenging. But for the first time, it's easier for people in the U.S. to find out what staff turnover is like at nursing homes in their area.

Medicare is now posting those details on its Care Compare website. Visitors can select a particular nursing home and then click to view staffing information.

Experts like Dr. David Gifford with the American Health Care Association say staffing turnovers at nursing homes are often high because of how payments are structured.

"We've historically been known to have a high turnover, as other sectors are too, and a lot of it relates back to that most of the nursing homes paid by Medicaid," Gifford said. "We just weren't able to offer the competitive wages that hospitals and other health care providers are."

The Centers for Medicare & Medicaid Services has researched the links between staff turnover and quality of care. Initial results suggest that as staff turnover decreases, the overall quality rating for a facility increases.

Starting this summer, the agency will use staff turnover information to calculate facility quality ratings.

Giffords says many workers at nursing homes do want to stay in their jobs. But he points to factors like low wages or child care problems as reasons for leaving.

"The staff there really do end up caring for the residents, almost as if their family members, and so it's very hard when someone leaves," he said. "We need to recognize that, and I think this data just shows that not making nursing homes sort of a priority has led to more turnover, and we need to solve that root problem with this information."

Medicare says posting the new turnover information for consumers won't create additional paperwork burdens for nursing homes. The data is already regularly reported to the government — it's just now becoming accessible to the public.

Studies have shown that the COVID-19 pandemic has caused more people around the globe to experience depression, anxiety and substance abuse. Now, a bipartisan policy center has created a task force to look into those specific issues and is proposing solutions that can help.

“The Bipartisan Policy Center is proposing that we advance the idea of integrating primary care and behavioral health services,” said Dr. Regina Benjamin, a former surgeon with the task force.

Benjamin is a doctor in a small town near Mobile, Alabama. She says in her own practice, she spends a lot of time looking for behavioral health specialists that can take patients in need of mental health care.

Part of the Bipartisan Policy Center’s new suggestions is to expand training to primary care providers so they can handle the treatment for mild to moderate mental health and substance abuse conditions. They also suggest bringing mental health nurses or psychiatrists into the same office as primary care physicians and have mental health providers available to provide care through telehealth.

“It would be so much more helpful if we had an integrated electronic health record that integrated with the psychiatrists or psychologists. Right now, those records don't talk to each other,” Benjamin said.

The Bipartisan Policy Center report also suggests moving to “value-based” care payment structures so doctors aren’t paid just for checking blood pressure but improving it.

The Center also wants to see Medicare coverage of telehealth permanently expanded.

“In the end, basically, this integrated system will improve access to services access to care. It improves the outcomes, it decreases the health disparities, it's cost-effective, it saves the system money and, at the end of the day, it helps us become a more healthy nation.”

The report mentions several states already moving toward physical and mental health care integration, demonstrating positive results and lowering costs through Medicaid.

CNCINNATI — Linda Hayes said the hardest thing she's ever done is place her husband, Bob, in a nursing home, knowing he will probably never come home again.

Her husband of 47 years suffers from Lewy Body Dementia, which causes him to hallucinate and have delusions, Hayes said. The disease can also make him angry and confrontational.

"It's just not fair," Linda Hayes said as she fought back tears. "He was the most kind, loving man you'd ever want to meet."

Courtesy of Linda Hayes

The challenge of finding the best care for her husband got harder during the pandemic, she said. She had the support of family and friends, but like many people, she was unaware that she could review detailed inspection reports for nursing homes to help inform her decision.

"No, I didn't even know to ask for that," she said.

After states banned visits for months during the pandemic, nursing homes have opened up again as they try to rebound from the worst days of the pandemic.

COVID-19 has killed nearly one out of every 10 nursing home residents, according to The COVID Tracking Project.

There's still so much many of us don't know about living conditions in local nursing homes. So, the WCPO 9 I-Team is trying to make it easier for you to get the information you need to find the best available care for your loved ones.

The I-Team has spent the last two months reviewing records for local nursing homes, including their ratings and inspection reports.

We've created interactive maps showing where you can find the highest- and lowest-rated nursing homes in the Tri-State and important information about each of those facilities.

We also interviewed advocates for nursing home residents and their families who shared key information that helps them identify quality long-term care.

Where to begin

The first step is identifying the type of care your loved one needs. Some people require skilled care, the highest level of long-term care. These facilities have around-the-clock nursing care.

People with Alzheimer's may need what's called memory care: Many people just need help with meals and basic services; those with Alzheimer's typically require assisted care.

The I-Team collected and reviewed records for facilities providing each type of care and the contact information for those facilities.

"It's important to have them close because you are going to be their biggest advocate," said Ashley Burke, an elder law attorney in the firm Burke & Pecquet in Blue Ash.

Lot Tan

Burke helped Linda Hayes with legal issues arising from the care her husband requires.

"It's not about the amenities or the decorations," Burke said. "It's about the care that the staff is providing."

A good place to start looking at quality of care is the Medicare nursing home compare website. It uses a five-star rating system. One star means the lowest rating; five stars mean the highest. It allows you to easily find facilities close to you by entering your address, then using other filters to identify nursing homes within a certain distance.

The website also provides details from federal nursing home inspections of the nursing homes, including any fines paid by the nursing homes.

The I-Team found 113 long-term care facilities within 20 miles of downtown Cincinnati. Twenty-six of them had an overall one-star rating.

Eighteen received an overall five-star rating.

The website breaks down the ratings into different categories: health inspections, staffing and quality of resident care.

The ratings provide a basic guide, but the I-Team found some nursing homes paid fines for poor resident care and still received a higher rating than facilities that had less serious violations.

One other important note: The ratings are based on previous inspections. They are not necessarily an accurate reflection of current conditions.

Still, the I-Team's investigation found the website is useful as a screening tool as part of your research on nursing home care.

Our interactive maps use data from the Medicare website. Each nursing home has a page in our database that contains a link to their individual Medicare inspection data and ratings.

We also included a link to an ongoing investigative project by nonprofit journalism organization ProPublica, which provides a rich collection of additional information about each facility, including the number of COVID-19 cases and deaths, along with actual inspection reports for the facilities.

The inspection reports are the most detailed public records available on individual nursing homes. The most serious violations are classified as "IJ" for "Immediate Jeopardy."

Inspection reports include the nursing home's response and a plan to address violations.

Visit, pay attention and ask questions

Before COVID-19, Linda Hayes said she made unannounced visits to nursing homes and requested a tour.

"That's when you really see what goes on behind the scenes," she said.

Something Linda Hayes said is most important to her is that her husband is close to her. He has lived in four different long-term care facilities, and each one has been 10-20 minutes from her home, which makes it easier for her to visit him more frequently.

"I just want him to be happy, if that's possible," she said.

Advocates for nursing home residents say regular visits lead to better care.

Zoom interview

"They're going to be able to be more involved," said Betheny Breckel, who worked as a nursing home social worker for 15 years before she became the district ombudsman for the Northern Kentucky district. "They're going to be able to see if their loved one is getting the care they're needing."

There's a Long-Term Care Ombudsman program in every state, providing guidance for families looking for nursing home care and acting as advocates for residents in those facilities.

Jodi Holsclaw, the regional ombudsman overseeing Northern Kentucky, said guests should eat meals served in the nursing home so they can see the quality of food being served.

"I always encourage families to do that," Holsclaw said. "Is it appetizing? Does it look appetizing?"

Zoom interview

Holsclaw said visitors should pay attention to details that can reveal a lot about how the staff cares for residents.

"Are there spills on the floor," Holsclaw said. "Are residents unkempt? Is their hair really long? Are their nails really long?"

Medicare publishes a nursing home checklist that can help your research, and Burke called the checklist "a good starting point."

While there is so much to consider when making such an important decision, Linda Hayes said it comes down to getting the best care you can afford as close to home as possible.

Then, share what you've learned.

"I hope it helps a lot of people," she said. "If it even helps one person, it will make me happy."

Resources

• Indiana Long-Term Care Ombudsman program

• Kentucky Long-Term Care Ombudsman program