Claims

Facility negligence claims based on federal law dismissed

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A federal judge has told the plaintiff suing a Kentucky nursing home that he could not proceed with his negligence per se claims based on violations of standards set by federal law or state licensing regulations.

Speech therapist faces 10 years for $3.7M in bogus claims

A 44-year-old licensed speech therapist faces 10 years in prison and a $250,000 fine after admitting she and a colleague submitted $3.7 million in fraudulent insurance claims for services either unnecessary or not provided at all. It serves as another stark reminder that providers need to know how their contractors are conducting business.

AHCA pitches 'permanent' therapy payment system

AHCA pitches 'permanent' therapy payment system

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Nursing homes' biggest national ally and advocate is making the rounds on Capitol Hill this week in an effort to convince Congress to let die a lengthy experiment to withhold therapy claims while it roots out fraud.

Ready, set ... Just kidding! (ICD-10 adventures continue)

Ready, set ... Just kidding! (ICD-10 adventures continue)

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Is that how everyone is feeling about the ICD-10 delays? Well, that's how I'm feeling. We almost got within the six-month window for implementation. Just when we were all geared up and ready to go, the government pushes the deadlines out again for one more year.

The three C's are the key!

The three C's are the key!

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How do you justify the reason for rehab, length of stay and intensity of treatment? You turn to the 3 C's.

Life Care Centers of America denies massive Medicare fraud charges; judge criticizes feds in secret whistleblower case

Life Care Centers of America denies massive Medicare fraud charges; judge criticizes feds in secret whistleblower case

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A U.S. District Judge has called federal prosecutors' years-long delay in announcing a Medicare fraud case involving one of the nation's largest nursing home companies "absurd."

Medicare auditors becoming more active, denying more claims, survey shows

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Requests for medical records by Medicare's fraud-detecting recovery audit contractors (RACs) jumped sharply from the first- to the second-quarter of fiscal year 2012, a new survey reveals.

Long-term care providers: plenty of reasons to look over the shoulder

Long-term care providers: plenty of reasons to look over the shoulder

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As if sobering news weren't in deep enough supply for long-term care providers, we've been reminded again why the threat of getting sued usually lingers in the back of the mind.

Lack of documentation accounts for Medicare fee-for-service error rate

Medicare's fee-for-service error rate for fiscal 2010 would have fallen if compliance contractors had successfully obtained better claims documentation, a federal report found.

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