OIG

RACs were 'most improved' healthcare auditors for getting back money in 2013, government report states

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Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.

Additional nursing home inspection rules are not the answer

Additional nursing home inspection rules are not the answer

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Many skilled care operators struggle to keep up with a seemingly never-ending array of survey and certification regulations. If two lawmakers get their way, providers can look forward to a large heaping of additional rules.

OIG changes its mind on referral services discounts

OIG changes its mind on referral services discounts

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Providers cannot use an online service that involves money for referrals within its network, federal regulars now say, reversing course on an advisory opinion issued three years ago. The edict came from the Department of Health and Human Services Office of Inspector General.

Nurses who don't pay taxes or student loans could trigger penalties for SNFs, expert says

Nurses who don't pay taxes or student loans could trigger penalties for SNFs, expert says

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Registered nurses who default on a student loan or fail to pay taxes could put a skilled nursing facility in the crosshairs of federal fraud investigators, a compliance expert told an audience Sunday at the American College of Health Care Administrators annual meeting in Las Vegas.

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.

Government report: 1 in 5 Medicare patients suffers an adverse event while receiving post-acute SNF care

Government report: 1 in 5 Medicare patients suffers an adverse event while receiving post-acute SNF care

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About 22% of Medicare beneficiaries experienced an adverse event during a post-hospitalization skilled nursing facility stay in fiscal year 2011, and the majority of these events were preventable, according to a newly released government report. Post-acute provider groups said many initiatives to lower this percentage already are underway.

Adverse events and the culture of fear in long-term care

Adverse events and the culture of fear in long-term care

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The government report on adverse events in post-acute care that was released yesterday shines a light on issues of real concern. However, as long-term care stakeholders and regulators consider the implications of the report and ways to reduce the number of adverse events, I'd suggest a companion report to be read alongside it: "Is Excessive Paperwork in Care Homes Undermining Care for Older People?"

Part A claims under scrutiny

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Government investigators will issue a report on skilled nursing facilities' Medicare Part A billing practices later this year, according to the latest annual work plan from the Department of Health and Human Services Office of the Inspector General.

HHS wants civil monetary penalty rules changed

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Civil monetary penalties for providers will be revised if two proposed rules from the Department of Health and Human Services Office of the Inspector General are approved.

OIG: Hospices often out of compliance, need framing

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The Department of Health and Human Services' watchdog arm recently said hospice providers need stronger oversight measures. It also noted more than $5.8 billion in recoveries in fiscal 2013.

Who's buying your loyalty?

Who's buying your loyalty?

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While the story of former Gov. McDonnell and his wife's alleged excess may make us shake our heads, it did remind me of the slippery slope many in business or politics can fall down when it comes to gifts.

Senior living company can pay referral fees for new residents despite kickback concerns, OIG advisory opinion states

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A nonprofit senior housing and care provider can continue to pay an agency for referring new residents, despite concerns related to anti-kickback laws, according to a newly released government opinion.

OIG probes hospitalizations

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A fourth of the 3.3 million Medicare beneficiaries who lived in a nursing home in 2011 were hospitalized for at least one day. This came at a cost of $14.3 billion, according to a Nov. 18 report from the Office of the Inspector General in the Department of Health and Human Services.

I pay dead people

I pay dead people

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On Oct. 31 (an ironic coincidence?) a report from the Office of inspector General frighteningly said Medicare paid some $23 million in benefits for more than 17,000 dead people in 2011. And my husband says I waste money.

OIG calls for more frequent surveys for hospice providers

OIG calls for more frequent surveys for hospice providers

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Hospice providers could soon be facing more recertification surveys, if the Department of Health and Human Services Office of Inspector General has any say in it.

RAC program needs better oversight, Inspector General report finds

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Recovery audit contractors might be better at reviewing Medicare claims than critics allege, but the Centers for Medicare & Medicaid Services could improve RAC performance evaluations, according to a new government report.

Progress in the hospital 'observation stay' chaos

Progress in the hospital 'observation stay' chaos

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When you complain about bizarre government conditions or regulations, as columnists are wont to do, you usually have to assume you're just whispering into a stiff wind. But now comes word that no less than the Office of Inspector General of your Department of Health and Human Services is jumping on the bandwagon to change the hospital "observation stay" madness.

Medicare paid millions in 'questionable' diabetes test strip claims related to SNF, hospital patients, OIG says

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Medicare is making questionable payments for diabetes test strips used by residents of skilled nursing facilities, according to a report from the Department of Health and Human Services Office of Inspector General.

NASL leader praises government investigation into medical equipment bidding process

NASL leader praises government investigation into medical equipment bidding process

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A government investigation could shed much-needed light on the Medicare competitive bidding process for durable medical equipment, prosthetics and supplies, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care.

Are you prepared? 5 questions you need to know the answers to

Are you prepared? 5 questions you need to know the answers to

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With all the recent regulatory changes that have come down the line, or are about to, we developed a simple five-question survey that each provider had to ask every therapy employee. If you can develop strong policies and procedures based on these questions, you will have a good offensive game plan in place.

Progress in trying to undo the hospital 'observation stay' mess

Progress in trying to undo the hospital 'observation stay' mess

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What is this world coming to? When you complain about bizarre government conditions or regulations, you usually have to assume you're just whispering into the wind.

Government agency calls off effort to assess antipsychotic use in nursing homes, watchdog group reports

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A government investigation into nursing homes' antipsychotic prescribing practices will not move forward due to budget and staff cuts, according to nonprofit investigative news organization The Center for Public Integrity.

Government presses therapy provider to repay $3 million in Medicare reimbursements

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A New Jersey-based outpatient therapy provider should pay back the government for $3.1 million in improper Medicare reimbursements identified in a recent audit, according to the Department of Health and Human Services' Office of Inspector General.

Ask the payment expert ... about quality and reimbursement correlations

Ask the payment expert ... about quality and reimbursement correlations

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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.

OIG issues new guidance for nursing homes on hiring people excluded from Medicare and Medicaid

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Nursing homes can now refer to newly updated government guidelines on hiring or contracting with people excluded from participating in federal health programs.

Latest whistleblower lawsuit pricetag runs to $2.7 million

Latest whistleblower lawsuit pricetag runs to $2.7 million

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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.

Report on Medicare payments for poor care paints skewed picture, nursing home advocates say

Report on Medicare payments for poor care paints skewed picture, nursing home advocates say

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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.

CMS may seek $225 million in uncollected Medicaid overpayments

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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).

Ask the legal expert ... about due diligence when being recruited

Ask the legal expert ... about due diligence when being recruited

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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?

Medicare has two more years to reclaim any overpayments

Medicare has two more years to reclaim any overpayments

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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.

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