Why nursing homes won't be catching many breaks this year
When you talk to experts in this field about the year ahead, an unsettling pattern soon emerges. Almost everyone seems fairly confident that regulators will be taking a much closer look at operators.
Among the things we can look forward to in the months to come:
- Closer inspections of Medicare bills that are turned in for payments
- Closer inspections of corporate integrity arrangements
- More incentives to disclose overpayments received
- More scrutiny associated with Sunshine Act reporting requirements
- More investigations targeting fraud and abuse by providers
- Greater data sharing between federal and state anti-fraud programs
- Increased False Claims Act litigation.
More could be added, but the point is made. What these developments collectively point to is an inescapable, troubling conclusion: Those outside the business simply don't trust those inside it.
Does that mean the field hasn't made great strides to clean up its act in recent years, to deliver better care or to hold itself more accountable? No. The reality is that this sector is full of caring, ethical people who are trying to do the right thing every day.
But here's the other side of the coin: It's hard for providers to insist they are good neighbors when so many of their peers act like grifters, or worse. Consider this sampling of headlines we've run recently:
Nursing home hospice provider kept patients in hospice for years, overbilled for their care, prosecutors charge
It's worth noting that these stories all broke over the last three weeks. It should also be noted that this is a far from complete accounting of the various black-eye developments that occurred.
Am I trying to pick on the good and decent people in this field? Far from it. But here's the thing: It's hard for providers to convince the rest of the world they wear the white hats when troubling developments suggest otherwise. It's apparent that operators will be under increased pressure to hold themselves accountable. As for getting the benefit of any doubts? I wouldn't bet on it.
John O'Connor is Editorial Director at McKnight's.