Medicaid

AOD acquires Stratis Business Systems, Inc.

AOD Software has bought Stratis Business Systems Inc., a home health and home care cloud-based software system.

Medicaid overbilling allegations were 'inaccurate' and 'misleading,' Signature HealthCARE says

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Authorities have asserted that Signature HealthCARE billed Medicaid for $2 million in unapproved costs, but this was an oversimplification that presented the company in an unfair light, the large long-term care provider contends.

Also in the news for July 7, 2014 . . .

Huge HIPAA breach inevitable, providers 'behind' crooks ... Nursing home doc has to pay back $57K to Medicaid ... Alzheimer's drug development not looking good ... Insulin pumps better than injections for diabetes care

Medicaid paying 32% less than Medicare Part D for medications

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Medicaid is paying the lowest average price for 78 high-use and high-expenditure brand-name and generic drugs, a new federal report finds.

Signature HealthCARE charged with $2 million in unapproved Medicaid billings

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Long-term care provider Signature HealthCARE billed Medicaid about $2 million for unapproved costs, auditors with the Tennessee Comptroller's Office charged Monday.

Take this to the bank: How to reduce money stress for LTC residents

Take this to the bank: How to reduce money stress for LTC residents

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In my conversations with hundreds of long-term care residents over the years, I've found money to be an almost universally sore subject among them. Financial concerns continue to be a stressor for our residents even though they're living in the mostly money-free society of LTC. With some adjustments we can — and should — reduce our residents' financial distress.

You'll never guess where the latest Medicaid relief is coming from

You'll never guess where the latest Medicaid relief is coming from

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If you are a long-term care provider relying on Medicaid dollars to make ends meet, Illinois is probably one of the last places where you'd want to be doing business. But Illinois also might have a program worth emulating wherever you are.

It's time to stop long-term care state rankings

It's time to stop long-term care state rankings

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Minnesota routinely is named best state for long-term care, as it was last week in AARP's 2014 scorecard. AARP held a panel discussion to unveil the rankings, and of course an official from Minnesota was on hand to share his state's secret sauce. But the panel also featured a speaker from Mississippi, one of the lowest-ranking states. I came away thinking that Minnesota actually might not have much to teach Mississippi — and questioning what these types of state rankings accomplish.

 New payment models present opportunities for SNFs

New payment models present opportunities for SNFs

For skilled nursing facilities, the Medicare SNF 3-day rule can make it difficult to place the right patients in the right setting at the right time. The 3-day rule requires that a Medicare beneficiary spend three nights in a hospital as an inpatient — observation stays do not count — before becoming eligible for Medicare-covered SNF care. This rule creates a challenge for SNFs as hospital lengths of stay decline for many of the conditions that SNFs treat.

Hospitalist company with long-term care presence faces federal charges of upcoding

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A hospitalist company that works with thousands of post-acute care facilities is officially facing federal charges that its clinicians routinely overbilled Medicare and Medicaid, authorities announced Tuesday.

Mother-daughter nursing home execs agree to lifetime Medicaid ban in case of $3 million fraud

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Former Florida nursing home executives agreed to be "permanently excluded" from federally funded health programs in settling charges of a $2.75 million Medicaid fraud, according to a plea agreement signed June 5.

Nursing home owner facing $3 million Medicaid bill gets jail time for financial misdeed

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A former nursing home owner who faces criminal charges and allegedly owes millions to Medicaid has been sentenced to 90 days in jail, Iowa officials announced Wednesday.

Emerging state approach to long-term care gives 'criminal intent' a whole new meaning

Emerging state approach to long-term care gives 'criminal intent' a whole new meaning

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States are beginning to consider a bizarre new long-term care strategy that has many providers rightfully concerned.

Dual eligibles more likely to go from hospitals to lower quality nursing homes, referral process might need reform, researchers say

Dual eligibles more likely to go from hospitals to lower quality nursing homes, referral process might need reform, researchers say

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People eligible both for Medicare and Medicaid go to lower-quality nursing homes after being hospitalized at a rate higher than Medicare-only patients, according to researchers from Brown and Harvard universities.

3 value-based purchasing strategies to help you get ahead

3 value-based purchasing strategies to help you get ahead

Long-term care providers have a stronger hook than they probably realize regarding the toughening of penalties for hospitals with high readmission rates.

New wrinkles for population experts — and providers — to consider

New wrinkles for population experts — and providers — to consider

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It's hardly breaking news that we live in an aging nation. But a look inside the latest round of numbers might give providers more reason to feel optimistic about remaining solvent once the age wave hits.

House bill would expand program to keep younger people out of nursing homes

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People younger than 55 would become eligible for a program to prevent unnecessary nursing home admissions if lawmakers pass a bill introduced Thursday in the U.S. House of Representatives.

Profile: A rare bird in Congress

Profile: A rare bird in Congress

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When Rep. Diane Black (R-TN) was around 4 years old, she asked for a doctor's kit. But growing up in a working class family in Glen Burnie, MD, the future nurse and Congressman didn't know how to pursue her healthcare dreams.

OIG spends $75M on Medicaid oversight, recommends cost-saving measures

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The Department of Health and Human Services Office of Inspector General spent $75 million on Medicaid oversight during the last fiscal year, a 4% increase over fiscal 2012, according to a new report.

Ryan budget proposal would hurt nursing home residents on Medicaid, critics charge

Ryan budget proposal would hurt nursing home residents on Medicaid, critics charge

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A Republican budget plan unveiled in the House of Representatives Tuesday would slash healthcare spending by $732 billion over the next decade, in part by reengineering Medicaid. The proposed changes could jeopardize benefits for a huge number of nursing home residents, critics said.

State News

State News

PENNSYLVANIA - The state's nursing home operators say they are approaching fiscal disaster as facilities look at razor-thin margins half the national average.

Feds recover $10 million in incorrect Medicaid payouts

Feds recover $10 million in incorrect Medicaid payouts

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Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.

CMS is failing to ensure that terminated skilled nursing facilities and other providers are not billing Medicaid, watchdog agency says

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The Centers for Medicare & Medicaid Services needs to do a better job of ensuring that terminated Medicaid providers in a particular state, including skilled nursing facilities, don't reappear in another state, according to a new government report.

Most continuing care retirement communities are not 'isolating' settings, CMS clarifies in guidance on recent regulation

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Continuing care retirement communities don't create the same problem of isolation as skilled nursing facilities, according to new guidance on a recently finalized Medicaid regulation.

Housing department announces $120 million in funding to help with Olmstead compliance

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State housing agencies can apply for $120 million in new federal funding to support housing options for disabled people transitioning out of long-term care facilities, the Department of Housing and Urban Development recently announced.

Providers could lose Medicaid money and patient information due to ICD-10 transition, researchers find

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Healthcare providers could experience financial and information losses when they make the mandated transition to the new International Classification of Diseases coding system in October, according to researchers at the University of Illinois-Chicago.

Privately managed Medicaid threatens long-term care quality and options, New York Times article states

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People with complex needs could find themselves squeezed out of the most appropriate long-term care settings as Medicaid beneficiaries become enrolled in programs from private sector companies, The New York Times reported in a lengthy Page 1 examination of the subject Friday.

Hospitalized seniors likely to need family help, study finds

Hospitalized seniors likely to need family help, study finds

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Nearly half of hospitalized seniors facing a major treatment decision require help from family members, a new study finds.

Medicaid-only long-term care residents driving up state expenditures, report finds

Medicaid-only long-term care residents driving up state expenditures, report finds

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Among people eligible for Medicaid but not Medicare, long-term care residents are most likely to be among the costliest beneficiaries for a state, according to a new report from the Government Accountability Office. Sen. Charles Grassley (R-IA) requested the report, noting that much research has focused on those eligible for both Medicaid and Medicare, but has largely overlooked the Medicaid-only group.

Franken reintroduces bill to facilitate rides from nursing homes to medical appointments

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More Medicaid dollars would flow to volunteers who drive nursing home residents to medical appointments under a bill recently reintroduced by Sen. Al Franken (D-MN). Seniors living in rural parts of Minnesota currently are scrambling to find rides, due to a dispute between transportation companies and Blue Cross/Blue Shield.

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