Athena nursing homes behind on paying worker health claims, CEO says

Athena Health Care Systems, one of the largest providers of long-term care in Connecticut, is six months behind on paying health claims for workers on its health plan, President and CEO Lawrence Santilli said in a memo to employees obtained by The Connecticut Mirror.

The Farmington-based company operates more than 40 long-term care facilities in Connecticut, Massachusetts and Rhode Island. In Connecticut, it manages 23 facilities from Middletown to Sharon and serves more than 2,500 residents.

There are about 2,500 workers on the company’s health plan.

“Previously I informed you that Athena was working diligently to address the employee health insurance payment issues. Unfortunately, the employee health plan currently has a significant funding shortfall,” Santilli wrote in the Nov. 27 memo to workers.

“Athena has not been able to promptly meet all the funding requirements of the employee health plan. As a result, we are approximately six months behind in paying submitted health claims. In our continuing efforts to address shortfalls with funding the health plan, we have hired outside personnel to assist us to properly administer the health plan moving forward.”

Santilli asked workers whose claims had been sent to collection agencies, whose credit had been damaged and whose out-of-pocket medical expenses had exceeded amounts they were required to pay to contact the company’s benefits manager.

“It is our intention to fully fund all outstanding claims in the upcoming new year,” he added.

In an emailed statement, a spokeswoman for Athena said the company continues to make payments on the employee health plan. She did not say how much in claims Athena is behind on paying.

“Despite the funding challenges, Athena Health Care Systems has been and continues to make payments to the employee health plans. The current situation is a result of a combination of factors including a surge in claim volume and funding, as the submitted claims are getting paid in the order in which they are received, processed, and then approved for payment,” the spokeswoman, Savannah Ragali, said.

“The Benefits Manager and consultants provide updates to the employees regarding their claim status. The outside personnel are also working to negotiate payment for the submitted health claims,” she said. “All notices that employees receive from collection agencies or changes to their credit report are asked to be submitted to the Benefits Manager for appropriate follow-up. … Our team is actively engaged in this, and we deeply appreciate the unwavering dedication of our staff in serving our residents and express our sincere gratitude for their continued commitment.”

Legislators and advocates said Athena’s failure to keep up with paying employee health claims undercuts efforts to recruit and retain workers in the field, which has been struggling with staffing shortages.

“People are hearing stories from their peers about not having their benefits paid, about sometimes having their paychecks be in jeopardy,” said Mairead Painter, the state’s long-term care ombudsman. “That’s scary for anybody.”

“It blows my mind,” said Rep. Jane Garibay, a Windsor Democrat who is co-chair of the legislature’s Aging Committee. “Paying your employees comes first. It’s not an easy job being a certified nursing assistant, being a licensed practical nurse or being a registered nurse, especially in a nursing home. Those employees, a lot of them live day to day. They don’t make a ton of money.”

“We don’t have the workforce” for the aging population, she added. “When I look at companies that are doing it right, they hire at even a little bit better than minimum (wage), they train, they have a progression where people can grow within the company. … If you’re not doing those things and people have a choice, why would a person become a CNA, when they can do something else, make more money and get better benefits?”

Sen. Cathy Osten, D-Sprague, said she was concerned about the late payments.

“It’s just not acceptable to not pay for people’s health care,” she said. “It impacts them receiving services at doctors’ offices and clinics. It’s not acceptable, and it’s an obligation they made with employees when they came in.”

“I mean, how do you take care of your preventative care if Athena’s not paying claims? It’s important that we on the [Aging] Committee fully understand what is going on and see if there’s something we can do to at least put a Band-Aid on it,” added Rep. Mitch Bolinsky, R-Newtown, a ranking Republican on the committee.

In response to concerns from lawmakers, Ragali said Athena remains committed to helping grow the long-term care workforce.

“The ongoing challenges posed by the COVID-19 pandemic have highlighted the vital role of health care professionals and Athena Health Care Systems is committed to help rebuild the long-term care workforce,” she said. “Our commitment extends beyond recruitment, reinforcing the positive image of the long-term care industry as a rewarding and fulfilling career choice.”

The problems with the employee health plan are not the first troubles for Athena.

Late last year, the company agreed to pay a $1.75 million fine to the Massachusetts Attorney General’s office for admitting people with substance abuse issues to its facilities without being able to provide appropriate treatment.

Six temporary employment agencies have filed lawsuits against Athena in Connecticut, alleging the company failed to pay them more than $142,000 for employees they provided since 2021 to offset staff shortages. Another lawsuit claimed Athena owed nearly $2 million for temporary workers provided by a separate company. And an Iowa-based insurance company filed a federal suit alleging Athena failed to pay more than $6 million in health insurance claims from its employees, an issue that prompted state officials to contact the U.S. Department of Labor to investigate.

Athena has also been cited over issues with staffing and patient safety in multiple states and has faced a wrongful death lawsuit.

Painter said her office was contacted by some Athena workers about problems with benefits, though she does not have the ability to intervene in employee health care matters. Athena’s staff is largely non-union.

“There’s a lot of scrutiny that we, as advocates, have been hard on the nursing homes, wanting to hold them accountable and not shining a light on the good things that are happening,” Painter said. “There are some fantastic nursing homes that treat their employees very well and do the right thing. But I think we need to be calling out and ensuring they’re all doing that, that they all provide good quality care and a good place to work and take care of their employees.”

Jenna Carlesso is a reporter for The Connecticut Mirror (https://ctmirror.org/ ). Copyright 2023 © The Connecticut Mirror.