June 01, 2013
How can the Centers for Medicare & Medicaid Services correlate quality of care and reimbursement? You always need to remember that Medicare is an insurance plan. As such, Medicare has rules, just like your insurance company. Two of those rules are that we must provide care according to an individualized care plan for each resident and that we provide appropriate discharge planning.
Nursing homes can now refer to newly updated government guidelines on hiring or contracting with people excluded from participating in federal health programs.
April 01, 2013
Federal authorities cracked down on another regional long-term care provider recently, reaching a roughly $2.7 million settlement in a lawsuit centering on alleged false therapy billing.
March 01, 2013
Skilled nursing facilities collected Medicare payments of $5.1 million in 2009 for care that did not satisfy government quality measures, according to a report released Thursday. Prominent nursing home advocates say they're taking the report seriously but counter that the Department of Health and Human Services Office of Inspector General (OIG) is presenting an incomplete picture.
The Centers for Medicare & Medicaid Services should press states to repay about $225 million in Medicaid overpayments accrued over a 10-year period, according to a recent report from the Department of Health and Human Services Office of Inspector General (OIG).
February 01, 2013
I'm an administrator and am being recruited by a skilled nursing facility with past legal troubles. What should I do to satisfy myself that this facility has cleaned up its act and would be a good place to work?
February 01, 2013
Providers will have to hold their breath a little longer after receiving Medicare payments, thanks to a little-publicized provision of recently signed fiscal cliff legislation.
January 23, 2013
The Office of the Inspector General's recent report about what it calls $1.5 billion in inappropriate Medicare payments to skilled nursing facilities should be yet another wake-up call to providers.
A facility that has proposed to offer grocery store gift cards in return for health screenings or clinical services will be sanctioned, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has announced.
Concerns about home- and community-based services (HCBS) at assisted living facilities were raised in a report released Tuesday by the Health and Human Services Office of Inspector General.
December 04, 2012
Regardless of whether you are big or small, nursing facility leaders need to be much more vigilant with compliance program efforts.
November 30, 2012
In what has become a frequent event, the Inspector General at the Department of Health and Human Services has just issued yet another report that crows about heroic fraud-fighting efforts.
November 30, 2012
EMRs are expected to become the norm for healthcare providers in the future. But in the infancy of their use, they lack oversight and safeguards, a new report says.
Tennessee needs to toughen up its Medicaid false claims law, the federal government says, and that might not be good for providers.
The projected recoveries to the federal government from fraud-related audits and investigations are expected to rise 33% — or by $1.7 billion — in fiscal 2012, the Department of Health and Human Services Office of the Inspector General said this week.
November 19, 2012
What happens when delegation without accountability takes place? We saw a good example last week, when the Office of Inspector General released a damning report about excessive Medicare charges from nursing homes.
November 13, 2012
Nursing home advocates are expected to kick into high-gear defense mode after a new federal report asserted Tuesday that providers are overcharging Medicare to the tune of $1.5 billion annually.
Nineteen percent of long-term care nursing aides who were found guilty of on-the-job abuse, neglect, or property theft in 2010 had prior criminal convictions, a federal report revealed this week.
Federal officials need to provide clearer guidance and offer a more streamlined protocol for providers willing to self-disclose Medicare overpayments, a leading long-term care group says.
August 01, 2012
A multimillion dollar Medicare fraud-fighting command center unveiled by the federal government a week ago is already drawing fire from two Republican lawmakers.
July 13, 2012
Antipsychotic drugs are often used to calm residents with dementia. This reality is common knowledge among most people who have spent more than a few minutes in a nursing facility. But it is apparently a great revelation to the folks at the Inspector General's office.
July 10, 2012
Many nursing facilities are not compliant with federal regulations governing residents who take atypical antipsychotic medications, a federal review released Monday reveals.
July 05, 2012
Medicare appears to have paid pharmacies twice for medications taken by hospice beneficiaries, a government report found.
The success rate of Medicare's volunteer force of fraud-detecting beneficiaries is declining, a government report finds.
June 20, 2012
A provider group is taking the Centers for Medicare & Medicaid Services to task for improperly using Medicare audits as a means of curtailing high-intensity therapy in skilled nursing facilities.
The vast majority of the medications used by people who are dually eligible for Medicare and Medicaid can find what they need through Medicare Part D formularies, a federal report finds.
May 30, 2012
If you're a Daily McKnight's reader, it's a good thing. Otherwise, you might have never known that a federal measure calling for closer monitoring of antipsychotic drug use in nursing homes was sidetracked late last week.
April 17, 2012
Having once slept through a 6.7-magnitude earthquake, driven blithely through snowstorms and regularly horrified my Kansas-born husband with my lack of knowledge about tornadoes, I am far from an expert on natural disaster planning.
Medicaid Integrity Contractors failed to find overpayments in the majority of their audits for the first half of 2010, leading the Office of Inspector General to recommend that the Centers for Medicare & Medicaid Services revise its audit process.
More communication is needed between Medicare and Medicaid's respective program integrity officials, a new report suggests.
