Top Medicaid fraud convicts are nursing and home health aides, OIG says

Top Medicaid fraud convicts are nursing and home health aides, OIG says

Nearly one-third of Medicaid fraud criminal convictions the federal government obtained last year involved home health aides, a government report finds. Thirty percent of the 2014 cases involved home health aides, while certified nursing aides were culprits in 9% of convictions.

Better provider policies needed in wake of historic Alzheimer's sex case, experts say

A 78-year-old retired lawmaker on Wednesday was found not guilty of sexually abuse of his Alzheimer's-afflicted wife. The Iowa case attracted nationwide attention and has been watched closely by many long-term care professionals.

Online forum will explain new home health rating system

A special one-hour, web-based open door forum will be held May 7 to explain to providers the new set of star ratings for the Home Health Compare website, the Center for Medicare & Medicaid Services announced.

Also in the News for Friday, April 24

Convicted nursing home killer says evidence destroyed .... Rhode Island zeroing in on Medicaid reimbursements ... AHCA lends support for Veterans Access bill ... Assisted living caregiver charged with raping resident

Omnicare said to be exploring sale

Omnicare said to be exploring sale

The nation's largest pharmacy services provider for nursing homes is believed to be looking for a buyer.

Proposals to pay for 'doc fix' law are making long-term care providers nervous

Much of last week's historic bill that created new payment rates for Medicare doctors was left unfunded by lawmakers, and now GOP budget hawks are presenting ideas that provoke anxiety in the sector.

Nursing home association wants no part of Medicaid managed care

Managed care is not being warmly embraced by long-term care providers everywhere. Nearly 40 states are in various completion phases of transitioning to privatized Medicaid managed care systems, but Louisiana's nursing homes are defiantly resisting efforts there to have them join the party.

New drug delivery system shows promise in managing Parkinson's

Medical researchers say a new treatment could effectively combat the biggest obstacle in managing Parkinson's Disease - the difficulty in absorbing medications because of erratic muscles that control digestion.

Also in the News for Thursday, April 23

Husband in Alzheimer's-sex case acquitted ... LTC Community Coalition releases state survey report ... Families for Better Care criticizes Florida assisted living proposal ... Medicaid applications lagging in NJ

HCR ManorCare 'vigorously' refutes multiple whistleblower allegations

HCR ManorCare 'vigorously' refutes multiple whistleblower allegations

HCR ManorCare said Tuesday it will "vigorously defend" itself in three separate "whistleblower" lawsuits that allege it submitted false claims to Medicare and Tricare.

Information security improves at Medicare contractors: OIG

Information security at nine selected Medicare administrative contractors, at least as of two years ago, was improving, according to a recent report by the Department of Health & Human Services Office of the Inspector General.

Assisted living assault now ruled homicide

Police said Monday that the death of a 93-year-old woman in a Winston-Salem, NC, assisted living facility is now being investigated as a homicide.

Also in the News for Wednesday, April 22

AHCA joins AHA and other groups in letter opposing sequestration extension ... Minnesota nursing home bill would link quality to payments ... Georgia Medicaid program owes $100 million in overpayments, feds say

Budget cut-hungry GOP walks fine line, eyeing 2016 elections

House and Senate Republican lawmakers began working on a budget this week that could propose slashing Medicare and Medicaid in an effort to work toward a balanced budget without fiddling with tax rates, according to published reports.

Social Security numbers to be removed from Medicare beneficiary cards

After more than 10 years of warnings by government investigators, the Centers for Medicare & Medicaid Services now has a mandate to remove Social Security numbers from enrollees' cards — a practice identified as one of the top personal financial threats seniors face today.

Peppers cooked in hooch lead to facility fire, evacuation

There's a lot that's unclear in an attempt to cook peppers in Everclear in an assisted living residence last week.

Also in the News for Tuesday, April 21

Maintenance worker accused of stealing $17,000 from assisted living resident ... Medicare beneficiaries should sign end-of-life directives, Jeb Bush says ... Tylenol may hamper emotions, study finds

Average SNF patient paid $3,400 when ineligible for Medicare, AARP report finds

Average SNF patient paid $3,400 when ineligible for Medicare, AARP report finds

New AARP research reveals that the use of hospital "observation" status is having a substantial impact on out-of-pocket healthcare costs and follow-up care decisions for many Medicare beneficiaries.

Self-reporting False Claims Act violation averts litigation

Long-term care providers would do well to know the lesson from one Pennsylvania continuing care facility, which averted costly litigation when it discovered and later reported irregularities of more than $1 million in Medicare claims.

Head of state association quits 'to preserve unity'

The long-time head of Georgia's most powerful nursing home lobby resigned last week, revealing a rift that had grown among providers. The exec had spoken out in favor of lesser funding from the state and spreading it to more than just a small group of providers.

Also in the News for Monday, April 20

Former assisted living worker sues employer over alleged defamation of character ... Nursing home workers protest for higher wages ... More people are doing end-of-life planning, study finds

Providers testify against post-acute bundled pay bill at hearing

Providers testify against post-acute bundled pay bill at hearing

A top nursing home advocate on Thursday urged killing a bill calling for the bundling of Medicare payments for post-acute care services.

Watchdog: CMS should monitor Recovery Audit Data warehouse

A new Government Accountability Office report recommends sweeping government reforms that would mitigate fragmentation and duplication of a number of Medicare and Medicaid programs.

Medicare doc payment bill doesn't 'fix' therapy caps

The historic repeal of the "doc fix" this week left about equal numbers of stakeholders relieved and disappointed. Among the most crestfallen: Therapy providers who were hoping for Congress to finally repeal Medicare Part B outpatient therapy caps.

Also in the News for Friday, April 17

CMS releases Hospital Compare Fact Sheet ... Nurse empowerment is needed to improve outcomes in long-term care, researchers say ... Florida lawmakers headed for overtime session over Medicaid fight

Colorado latest state to bungle Medicaid claims data: OIG

Long-term care providers are struggling to satisfy new mandates over electronic reporting and medical records, and can expect more in the near future. But nothing can compare to the kind of information technology nightmares some state Medicaid departments are currently reeling from.

'Many' SNF workers rely on public aid: Report

If rising discontent with wages hasn't raised eyebrows in your nursing home, there's a decent chance it could in the upcoming campaign season.

Christie calls for Medicare, Social Security cuts, greater state control of Medicaid

Few things signal the fresh start of a presidential campaign season better than stump speeches calling for Medicare and Social Security cuts. And 2015 is no exception.

CMS: Medicare SNF reimbursements to rise by $500 million

CMS: Medicare SNF reimbursements to rise by $500 million

Medicare would increase skilled nursing facility reimbursements by 1.4%, or $500 million, in 2016 under an updated payment rate proposed Wednesday.

Also in the News for Thursday, April 16

LeadingAge's Barbara Gay lays out how 'doc fix' bill impacts providers ... Diabetes, depression create even higher risk for dementia than previously thought ... Connecticut nursing home strike postponed ... Feds say Missouri Medicaid program failed to bill for $50 million in rebates

Nursing home operators hail 'historic' Senate passage of permanent 'doc fix' bill

The Senate overwhelmingly voted to pass H.R. 2 Tuesday night, paving the way for repeal of the Medicare Sustainable Growth Rate and drawing the praise of the largest nursing home association in the country.

CMS posts specifics on staffing, payroll data collection for Five Star ratings

CMS posts specifics on staffing, payroll data collection for Five Star ratings

The government has posted technical specifications showing long-term care facilities how to electronically submit staffing information based on payroll data under a new system that becomes mandatory in July 2016

Facility negligence claims based on federal law dismissed

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.

Also in the News for Wednesday, April 15

Nursing homes chase Medicare patients: NYT ... Nursing home dog makes rounds via elevator ... Kentucky looks at new Medicaid managed care contracts

Social activities can reverse brain atrophy: Study

Johns Hopkins researchers say meaningful organized social activities could stop, and in males actually reverse, declines in volume in regions of the brain vulnerable to dementia.

Nursing home operators urge swift Senate approval of physician pay formula

Nursing home operators urge swift Senate approval of physician pay formula

The American Health Care Association and National Center for Assisted Living are urging the U.S. Senate to act quickly on a potentially historic bill for establishing Medicare rates for doctors.

Federal judge sends nursing home's libel lawsuit against law firm back to state court

A U.S. District Court judge recently sent a lawsuit between a Mississippi law firm and an Ohio nursing home back to state court after determining the law firm failed to show sufficient evidence that the amount of alleged damages warranted the matter being in federal court.

Results you can dance to: Tango beneficial for Parkinson's patients

Canadian scientists say their research shows that dancing the Argentine tango can improve balance and provide "modest" benefits on cognition and fatigue in patients with Parkinson's disease.

Also in the News for Tuesday, April 14

Former RehabCare CEO killed in plane crash ... Texas Medical Board votes to restrict telemedicine ... VA Senator pushes for long-term care legislation, discusses mother's Alzheimer's ... Montana legislators vote for Medicaid expansion

Judge rules for Beverly and Aegis in FCA whistleblower lawsuit

A nursing home and a rehab therapy provider recently beat a federal whistleblower lawsuit because the government's expert witnesses relied on the wrong standard to show why certain therapy services were "medically unnecessary."

Impact-absorbent flooring cuts injury rate by 59%: Swedish study

Swedish researchers say they have produced the first "statistically significant" proof that impact-absorbing flooring can provide measurable benefit in preventing injuries from falls inside nursing homes.

Also in the news for Monday, April 13

Feds say health IT vendors hindering reform efforts ... Mental practice and physical therapy effective for stroke survivors ... New guidance on contact precautions for facility visitors ... Middle-aged, underweight brings one-third greater dementia likelihood.

CMS actuary throws cold water on 'doc fix' bill projections

CMS actuary throws cold water on 'doc fix' bill projections

Long-term care leaders who have widely endorsed a House proposal to permanently "fix" the Sustainable Growth Rate formula, might be suffering buyer's remorse after learning Friday that the bill might not provide the lasting relief it promises. But they're still hopeful as the Senate reconvenes Monday.

Ventas SNF spin-off could set trend, analysts say

Ventas SNF spin-off could set trend, analysts say

Chicago-based Ventas' announcement that it will be spinning off its skilled nursing facilities could have a snowball effect among other long-term care healthcare investors, analysts believe.

NLRB guidance speeding up union procedures takes effect Tuesday

Procedures for petitioning for union representation are changing April 14, when a final rule proposed the National Labor Relations Board (NLRB) go into effect.

DOL compels providers to pay $6.8 million for lost wages, underpayments

More than 1,300 low-wage workers in northern California will get about $6.8 million in back pay from nursing homes and other long-term care facilities as a result of an ongoing U.S. Department of Labor probe.

Also in the news for Friday, April 10

Genworth: Private SNF room charges now $91,000 ... Seniors housing occupancy declines in 1Q ... Lower extremity revascularization mainly palliative ... Modifications to Medicare Advantage star ratings withdrawn.

Medicaid expansion a boon for early adopters: Report

Medicaid expansion a boon for early adopters: Report

A new report produced for the prestigious Robert Wood Johnson Foundation concludes that Medicaid expansion provides a "win-win" for participating states and the government.

CA man gets 30 months in prison, hefty fine in clinic 'fraud' case

A San Diego man will serve 2½ years in custody after being ordered to repay the government nearly $1 million for what prosecutors say were phony Medicare claims for medically unnecessary and unsupervised tests on unsuspecting seniors, the FBI reported.

Reagan's speeches provide Alzheimer's clues

Researchers say they have uncovered subtle clues of early dementia in Ronald Reagan's presidential speeches from years before he was formally diagnosed in 1994.

Also in the News for Thursday, April 9

ALFA will establish a separate credentialing organization for industry certification ... Missouri researchers create new dysphagia model ... New York makes "unprecedented investment" in Alzheimer's care ... Nursing union alleges surveillance ... NLRB general counsel gives guidance on final union election rule

Nursing homes' progress noted in QIO report

Nursing homes' progress noted in QIO report

Significant reductions in adverse drug events, infections, wounds and use of restraints in nursing homes are among the key achievements touted this week by federal regulators.

Also in the News for Wednesday, April 8

Leg revascularization does not help nursing home resident outcomes ... Man arrested after being accused of breaking into nursing home and holding resident, nurse hostage ... Florida governor changes mind on Medicaid

Mental health would have coverage parity with medical care under federal proposal

The Centers for Medicare & Medicaid Services has announced a proposed rule that would require Medicaid managed care patients to receive the same level of coverage for mental health and addiction treatment as they do for medical and surgical care.

Nation's eyes shift to trial where Alzheimer's and marital consent issues collide

A trial centers on the brief marriage of two people in their 70s, with one going on trial for having sexual relations with his wife after being told she suffered from Alzheimer's disease.

MedPAC mulls plan to stop covering some 'low value' procedures

MedPAC mulls plan to stop covering some 'low value' procedures

Congress' advisory panel for Medicare payment policy is considering a plan that would stop covering certain "low-value" procedures and tests because their return on investment isn't good enough.

Ventas to spin off SNF portfolio after hospital chain purchase

Just a month after spending $2.9 billion to acquire medical office buildings and senior housing assets, Ventas announced Monday it will spin off its skilled nursing facility portfolio following the new acquisition of a 14-hospital chain in the Southwest.

Also in the News for Tuesday, April 7

CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans ... Assisted living resident accused of stabbing roommate ... Connecticut debates letting spouses of nursing home residents keep more assets

Controversy erupts after webcam removal from disabled resident's nursing home room

It's not clear yet whether Pennsylvania will become the fifth state to adopt rules or laws prohibiting or allowing private video recording or surveillance in nursing homes. But one Philadelphia nursing home's struggle to deal with the technology created a storm of controversy recently.

Day in the Life: Hog heaven in Colorado

Day in the Life: Hog heaven in Colorado

The love for dementia residents at the Intermissions Program at Wind Crest in Highlands Ranch, CO, isn't ham-handed. Residents are delighted when two pot-bellied pigs, Boris and Pumba, visit and provide affection.

Reinventing rehab

Reinventing rehab

SNFs have increased their presence in rehab for years, and now many need to replace, restore or otherwise reinvigorate their programs.

Case could change nursing meal breaks

A California court case concerning waived breaks could have widespread implications for healthcare workers encouraged to give up meal time during extra-long shifts.

Editor's desk: Stars losing their luster for 'punished' providers

Editor's desk: Stars losing their luster for 'punished' providers

One gets the feeling that federal regulators, no matter how proper the official talk went, took a bit of pleasure in sending a message to providers when recently rebasing their star ratings.

Locking the box

The HIPAA landscape evolves for providers as cloud storage, mobile devices and large-scale cyber attacks present new challenges to security and privacy efforts

How to do it... Resident security.

All of the bells and whistles in the world won't protect your staff and residents unless you spend the proper time and resources beforehand preparing for a new security system. Transitions from old to new systems can be risky. Experts offer advice on how to do it well.

Ask the Nursing Expert about ... CPR

Ask the Nursing Expert about ... CPR

How is the decision made whether a resident should be resuscitated?

Nurse-directed intervention eases heart disease, diabetes

Nurse-directed intervention eases heart disease, diabetes

Having primary care nurses promote physical activity could be effective enough to reduce heart disease and Type 2 diabetes risk among seniors, according to a British study.

Older residents ahead?

Older residents ahead?

Conventional wisdom holds that the sweet spot for long-term care residents is around age 85, give or take. But what if that figure were to increase dramatically?

5 Star is expanding as tweaks continue

5 Star is expanding as tweaks continue

Nursing homes entered a new era of tougher government scrutiny on Feb. 23, when officials released rebased Five Star ratings.

Records reveal seller's market

Operators selling properties saw their best year ever in 2014 — and 2015 could be even better.

CMS: Quality is improving

CMS: Quality is improving

A comprehensive review of Centers for Medicare & Medicaid Services' quality measurement efforts since 2006 paints a mostly positive picture of quality measurements in nursing homes.

Don't pump up the jams: study

Playing music too loud, or even just in the background too much, could impede seniors' ability to remember simple concepts, including names.

Dehydration is hard to change

A systematic review of 23 published research studies on the risk of dehydration in people 65 and older left researchers with little conclusive evidence about causes or a solution, investigators reported in the Annals of Long-Term Care.

Providers pushing for death of therapy caps

Providers are seeking legislation to end old therapy cap rates and to see changes in manual medical review process for therapy claims.

Feds praise newest ACO model

Federal regulators recently unveiled a new accountable care organization model they feel will appeal to long-term care operators.

60 Seconds ... with Susie Mix

60 Seconds ... with Susie Mix

Managed care is being seen as the answer to control our significantly increased healthcare costs. With the magnitude at which managed care is growing and spreading throughout the nation, it is evident managed care is here to stay for quite some time.

More changes ahead for the current ratings system: feds

More changes ahead for the current ratings system: feds

Staffing and retention rates are expected to be added to the Nursing Home Compare website in 2016.

Medicare payment group changes name

A Medicare payment watchdog group saddled with huge case backlogs and heavily criticized for causing delays in resolving reimbursement issues has changed its name and location on the web.

White House forums eyeball Medicaid funding concerns

The White House Conference on Aging is collecting comments from long-term care stakeholders through a series of regional forums across the U.S. about their concerns regarding the future of Medicaid funding.

RAC battles move forward

The debate over whether Recovery Audit Contractor audits are an incentive-laced system of provider harassment or a necessary tool to redistribute misspent Medicare funds continues. Neither side appears to be backing down

Ask the payment expert ... about RACs

Ask the payment expert ... about RACs

I thought the Recovery Audit Contractors were on hold, so why did I receive a request from our RAC for a Medicare Advantage resident?

Ask the care expert .. about drug diversion

Ask the care expert .. about drug diversion

Early identification of diversion and abuse benefits everyone involved. However, don't jump to conclusions before you are sure of the actions that are making you uncomfortable.

Researchers testing C. diff vaccine in widespread trial

Researchers testing C. diff vaccine in widespread trial

An international trial is examining the efficacy of a vaccine for C. difficile, the gut-destroying bacterium that is particularly dangerous to seniors.

Blood pressure drugs linked to mortality

Too many blood pressure medicines in patients over 80 could be dangerous if they have low systolic pressure, new European research reveals.

I Couldn't Live Without ... Eldermark

I Couldn't Live Without ... Eldermark

While preparing to open Avanti Senior Living communities, COO Lori Alford needed the right electronic medical records system.

Telemonitoring savings are not significant, study finds

Despite new research suggesting that a majority of U.S. adults - 56% - now embrace using a connected device at home to monitor health and share data with caregivers, telemedicine may not be the savior some forecast it to be, according to a study by Mayo Clinic and Purdue University scientists.

Clean it up, throw it out

Clean it up, throw it out

Whenever I pass one of those cinderblock mini-storage places with double-loaded rows of strictly functional corridors, I think the same thing: "That looks like some nursing homes I've been in."

Ask the treatment expert ... about palliative wound care

Ask the treatment expert ... about palliative wound care

Palliative care is focused on the relief of symptoms with a goal to improve the quality of the individual's life.

FDA approves first biosimilar treatment

The Food and Drug Administration approved its first biosimilar product in March, opening the door for more costly drug alternatives.

New tech tools help operators recruit staff more effectively

New tech tools help operators recruit staff more effectively

Long-term care providers are increasingly turning to technology that can recruit or track new hires, with the latest system coming from OnShift.

The future of care may swim in the ocean

It may sound fishy, but a popular dinner in many homes — tilapia — could also help wounds heal faster, according to a study out of Shanghai Jiatong University School of Medicine.

Custom chair cushions might aid spinal cord injury patients

Custom chair cushions might aid spinal cord injury patients

Wheelchair cushions designed to adjust to a person's size and form can help redistribute pressure and provide support for activities of daily living for patients with spinal cord injuries, report scientists at the Instituto Nacional de Rehabilitación (Rehabilitation National Institute) in Mexico City.

Profile: Ed McMahon, Ph.D.

Profile: Ed McMahon, Ph.D.

When he's not busy working to improve the quality of life of residents at Sunrise Senior Living's more than 300 assisted living communities, Ed McMahon, Ph.D., can often be found perfecting his recipe for mulligatawny soup or planning his next trip overseas with Wade, his husband of 30 years.

Advocates: Cost-relief decision hurts Medicare beneficiaries

After giving the ruling a few days to sink in, several patient advocate groups now say a Supreme Court decision will end up hurting Medicaid beneficiaries more than anyone.

SNF group cries foul over attorney general's contingency deal with private law firm

Pennsylvania's probe into alleged staffing problems at several nursing homes are among the latest to call into question certain kinds of arrangements.

Also in the News for Monday, April 6

New Jersey can kick out non-citizens from Medicaid ... Woman pleads guilty to running illegal assisted living program out of her apartment ... Multidrug-resistant shigellosis hits U.S. ... Preferred Care defends treatment of residents

Brookdale 'whistleblower' suit dismissed

Brookdale 'whistleblower' suit dismissed

A federal judge has dismissed a former Brookdale Senior Living employee's False Claims Act suit against the company while leaving the door open for an amended complaint, according to published reports

Appeal sought after ruling on arbitration clauses

Appeal sought after ruling on arbitration clauses

Plaintiffs in a negligent death lawsuit are asking the Texas Supreme Court to reconsider its recent ruling giving providers more leeway in forcing arbitration over alleged negligent care.

Poor staffing led to poor care, state says in lawsuit

New Mexico has filed suit against one of the nation's largest nursing home operators for providing what it claims were inadequate resources that led to poor care and improper billing. One leading patient advocate called the action a "new and novel approach" to the "chronic and longstanding problem of inadequate nurse staffing in nursing facilities."

Bankrupt nursing-home monitoring firm execs plead guilty

Executives from former nursing home resident monitoring firm Samarion Solutions face up to five years in prison and $250,000 fines after pleading guilty to conspiracy to defraud their firm's investors.

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