by James C. Sherlock

Virginia authorities have criminally charged 18 employees of Colonial Heights Rehabilitation and Nursing Center (CHNRC) with criminal acts in the terrible suffering and death of a woman from sepsis alleged to have occurred because of negligence in that facility.

In Part 3 of this series we discussed who else may be responsible.

We introduced the sister chains (affiliated entities) Medical Facilities of America (MFA) and Innovative Healthcare Management (IHM), owners of CHNRC and 43 other nursing facilities in Virginia and North Carolina.

That assessment is no longer accurate with yesterday’s release of new CMS ownership data. 

IHM is gone. Virginia SCC records show it as inactive. It lingers now only in historical records. We can only speculate at the reason for its demise and that decision’s relationship, if any, to the Colonial Heights death.

But all of the former IHA nursing facilities including Colonial Heights today show MFA logos (the sprig of leaves) on their websites. They advertise “New Ownership, New Leadership, New Vision.” Really. That is what they wrote.  But it is not actually new leadership, just a new flag.  Somehow MFA is never named in the website.

 MFA and IHM have long been run by the same leaders under fluid corporate structures.

Israel Birnbaum portrays himself on Linked in as “Partner at MFA/Innovative Healthcare/Concordia properties” and on Crunchbase as CEO, Owner & Partner of nursing facility company Vita Healthcare Group. All are in Lakewood, N.J., as is Heritage Consulting, a newer company and an additional business card for some MFA executives. He should update his profile. Innovative Healthcare Management (IHM) and Vita are gone.

Mr. Birnbaum’s personal listing in CMS ownership records shows key roles and ownership in ten Maryland nursing facilities, seven of which provide him with W-2’s. Those records show he has had those roles for years.

Each of the ten show the MFA logo on their websites, but CMS records do not show those facilities with any affiliated entity relationship.  

Perhaps one can go to the skilled nursing page on the MFA website and click on “locations” to find those Maryland facilities.  No luck.  404 error.

Mr. Birnbaum has been a corporate officer and W-2 managing employee for Maryland’s Adelphi Nursing and Rehabilitation Center since March of 2020. It is flying an MFA flag and offers the same “New Ownership, New Leadership, New Vision” assurance we have seen before.

Surely Medicare Compare lets users know about the MFA connection. Again, no.  “Affiliated entity name – None – This facility isn’t part of an affiliated entity.”

It matters a lot. The CMS ownership and facility performance databases are incomplete.

• CMS does not know about the connection, and all of its analysis and reporting on MFA derived from its data miss the Maryland, Delaware and Pennsylvania facilities;
• People looking for a place for mom on Medicare Compare will not know.
• Lawyers and investigators searching those databases for MFA will miss those assets.

Moshe Rajchenbach. Another key leader of MFA and IHM (and Vita Healthcare) has been Moshe Rajchenbach. He also has a Heritage Consulting connection.

Mr. Rajchenbach’s CMS ownership data downloaded yesterday from the Skilled Nursing Facility All Owners database (to which I added information from the Provider Information database) show him active at 13 MFA facilities in four states. He draws W-2’s from five facilities spread across Virginia.

Those data, provided by the company, show him as both the W-2 Managing Employee of Colonial Heights Rehabilitation and Nursing Center and the holder of its mortgage.

So, I called Colonial Heights yesterday. The operator, who was quite pleasant, had no record of him. So, I rang up Westport Rehabilitation and Nursing Center in Richmond, which also provided him with a W-2. The operator was similarly helpful. Same answer about Mr. Rajchenbach: not listed on the company directory.

Short version: They had never heard of him.

The “corporate officer” work could be done from New Jersey. But a cynic might wonder about the W-2s from Virginia.

Even more interesting are CMS records downloaded in August of 2023 that showed Mr. Rajchenbach with varying responsibilities for all 42 MFA and IHS facilities in Virginia and North Carolina. He assumed those responsibilities in four batches between Jan 17, 2020, and Jan 5, 2023 (Colonial Heights).  He still had ownership interest in four of them and held a mortgage on the Colonial Heights facility.  

CMS records on nursing home ownership publish what is submitted to them verbatim, including errors and omissions.

Some owners have played a shell game,

• submitting incomplete and inaccurate data;
• changing “owners” by changing the names of affiliated entities (chains) and direct (active) ownership LLCs without any change of the personnel involved or of the indirect (passive) investors;
• and omitting names of senior management by attaching names of subordinates to the reports.

That kind of information disconnect at CMS is not unusual. They only know what is submitted to them. They are trying to fix the problem.

Five days before Christmas of 2024, CMS published major new guidance. New and renewing annual ownership profile submittals are due NLT May 1, 2025, on a newly expanded form. Because it will spoil the game, expect industry lobbyists to try to get the changes cancelled.

Other records. 

MFA today offers 716 jobs in Virginia, Maryland, Pennsylvania, Delaware and North Carolina. Potential staff are not stupid. They can look up the same Medicare Compare data that consumers have available for mom. They won’t see MFA listed for some of its properties, but the staffing data tell the tale about facility conditions.

Nurses certainly have options. Nursing homes do not top the lists of most. They go where they are paid a decent wage and benefits and have a chance to succeed at what they do. Most nurses in understaffed facilities leave very quickly.

A check of the Virginia State Corporation Commission Clerk’s Information System lists 47 Medical Facilities of America entities. They show a long list of limited partnerships with LTC Holdings as the registered agent but some with MFA as the agent are still active. Ms. Graeff listed there is a Roanoke attorney.

In 2021 LTC Holdings, the U.S. Attorney for the Eastern District of Virginia announced that LTC Holdings agreed to settle Americans With Disabilities Act allegations. It indicates that LTC Holdings “previously operated nursing facilities under the name Medical Facilities of America, Inc.” I have no idea what the term “previously” meant.

LTC Holdings is another label on the same jar.

Bottom line. The leaders of Medical Facilities of America under all of its many names own the corporate shape-shifting, the information that they provided to the government, the information they have denied the government, and the records of their nursing facilities.

At the nursing facilities, they understaff across the board, create environments where few want to work and staff turnover is sky high and then profit from the misery that ensues.

In the case of Colonial Heights facility, Mr. Rajchenbach had direct control. Patient admissions could have been cut back to allow available staff to care for a reasonable patient load. They were not.

From the inspection report in late 2021, MFA leaders had direct warnings of both the conditions at that terrible place and the potential for patient harm. It perfectly predicted a case like the death of that woman in October of last year. Colonial Heights Rehab and Nursing Center realized a 17% profit margin there in 2022.

It is not my place to give recommendations to the investigators of the wrongful death of that poor woman, so instead I offer them the information within the first four parts of this series. But many will be disappointed if the indicted Colonial Heights employees are hung out alone on this case.

Senior management is, or should be, accountable for its actions.

Postscript. We are not nearly done.

Next, we will discuss the investors and the private equity marketplace centered on Lakewood, N.J., that bets on bad nursing homes like promising poker hands.

Then:

• Governments have a lot to answer for.
• Hospitals and assisted living facilities continue to refer patients and residents to some of the nursing hell holes in Virginia.
• Insurers, including Medicaid and Medicare, offer “managed care.” In this case, “managed” is an accusation, not a compliment.
• Then there are the doctors, nurses, social workers and other “mandated reporters” governed by state law and state boards who saw the conditions and said nothing.

We’ll look.

Finally, Colonial Heights Rehabilitation and Nursing is hardly a one-off. It is a shameful story, and one not limited to Medical Facilities of America.