OIG Takes Back $48M in Fraudulent Medicaid Payments as Nursing Homes Lead List of Open Cases

Despite the second straight year of declines in overall recoveries, the Department of Health and Human Services’ (HHS) top watchdog arm took back nearly $50 million in Medicaid reimbursements from nursing homes in fiscal 2018. The HHS Office of the Inspector General (OIG) this week reported a haul of $48.7 million from nursing providers accused […]

Crackdown on Improper Medicare SNF Payments May Cost More Than It Saves

The Department of Health and Human Services (HHS) made a splash last month when it claimed that skilled nursing facilities received $84 million in Medicare payments for treatments that didn’t qualify — but now a group of doctors claims that the proposed cures might be worse than the disease. Writing in a blog post for […]

Ensign Group Completes Five-Year OIG Oversight Agreement

Leading skilled nursing provider The Ensign Group (Nasdaq: ENSG) on Thursday announced that it has successfully completed a five-year Department of Health and Human Services (HHS) oversight period. The Mission Viejo, Calif.-based company initially entered into a corporate integrity agreement (CIA) with the HHS Office of the Inspector General (OIG) back in October 2013; at […]

Avoiding Million-Dollar Medicaid Eligibility Mistakes in Nursing Facilities

Skilled nursing operators can’t control day-to-day Medicaid rates in their states, but they do have a broad toolbox that can help them avoid eligibility errors and oversights that can cause millions in losses. In an era of constricted Medicaid reimbursements, frontline staff can still play a crucial role in maximizing dollars, sb2 Inc. CEO and […]

Lawmakers Again Take Aim at ‘Observation Stay’ Rules for Medicare SNF Coverage

A bipartisan coalition of federal lawmakers this week took another stab at clarifying the rules regarding a frequently confusing aspect of skilled nursing coverage under Medicare. Under the terms of the proposed legislation, the Improving Access to Medicare Coverage Act of 2019, so-called “observation stays” would count toward the three days of inpatient acute care […]

Texas Floats Plans to Boost Medicaid Funding Through SNF Quality Program

After a high-profile bankruptcy in December of last year, Texas now has two bills that aim to provide some Medicaid reimbursement relief to skilled nursing providers in the state. The bills, Senate Bill 1050 and House Bill 3342, would establish a long-term care quality provider participation program (QPPP) in the state that provides additional compensation […]

Trump Budget Plan Would Cut $845B from Medicare, $241B from Medicaid

The White House on Monday released a budget proposal that would substantially slash Medicare and Medicaid spending over the next decade. In part by adopting a site-neutral payment model for post-acute care under Medicare and converting the Medicaid system to block grants, the federal government would end up gutting more than $1 trillion from the […]

CMS to Crack Down on Staffing, Separate Short- and Long-Term Stays in SNF Star Rating Overhaul

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced stricter standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays. Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in […]

Paul Ryan: Medicare Advantage is the Future of Medicare, and Medicaid Reform Will Return

Public-private partnerships will form the basis of comprehensive Medicare reform as the baby boom population ages, former Speaker of the House Paul Ryan predicted Thursday morning in remarks at a major skilled nursing and senior housing industry conference. “I believe the future for Medicare is in the Medicare Advantage type of space,” Ryan, a Wisconsin […]

New Jersey Eases Nurse Licensing Laws Amid CNA Shortage in Nursing Homes

New Jersey Gov. Phil Murphy on January 31 signed into law a bill that allows nursing aides with out-of-state certifications to use their licenses to care for people in the Garden State. The bill was sponsored by Republican state Sen. Robert Singer. “The number of job openings for certified nursing assistants is staggering,” Singer said […]

South Dakota Nursing Home Leaders See ‘Statewide Disaster’ Without Medicaid Increase

Nursing homes in the state of South Dakota are facing a $42 million annual shortfall in Medicaid reimbursement, which has led to the closure of several facilities. Without an increase, industry leaders said, the closings could lead to “statewide disaster.” The Argus Leader first reported the story. Nine nursing facilities have already closed, two are […]

CBO: Nursing Homes Account for 15% of All Medicaid Spending as Aging Population Drives Costs

Programs for Americans aged 65 and older will account for nearly half of all the federal government’s non-interest spending in the next decade, a new report from the Congressional Budget Office found, as the baby boom population continues to age into both Medicare and certain Medicaid benefits. Medicare, Medicaid, and Social Security spending will balloon […]

MedPAC Unanimously Calls for $2 Billion in Skilled Nursing Payment Cuts in 2020

After floating a proposed recommendation to slash nursing homes’ Medicare reimbursements for fiscal 2020, a leading legislative voice on health care issues made it final last week. The Medicare Payment Advisory Commission (MedPAC) called on Congress to reduce funding for skilled nursing facilities by up to $2 billion in the next fiscal year, citing sufficient […]

NY Falls Short on Nursing Home Enforcement, State Senator Says

New York is among the top 10 states with the greatest number of nursing homes. But according to one state senator, the Empire State isn’t doing enough to enforce its existing regulations for standards of care — and needs new legislation to bring nursing homes up to speed. State Sen. Robert Ortt, a Republican whose […]

Skilled Nursing Industry Split on Whether PDPM Will Boost or Cut Revenues

Leaders from multiple segments of the post-acute and long-term care industry have expressed optimism about increased reimbursements under the new Patient-Driven Payment Model (PDPM), but a survey of Skilled Nursing News readers revealed a much murkier picture. In the month of December, SNN asked our readership — which includes executives and other leaders at operators, […]

Federal Shutdown Halts $3.6B HUD Loan Program for SNFs, and Backlog Will Linger

The partial government shutdown has brought a multi-billion-dollar program for skilled nursing facility acquisitions and refinances to a halt, and the backlog could complicate deals long after the impasse eventually ends. The Department of Housing and Urban Development (HUD) has stopped endorsing loans, the final step toward closing deals through the Federal Housing Administration’s (FHA) […]

New York Lawmaker Moves to Bolster Nursing Home Oversight

New York State Senator Rob Ortt said in late December that he would propose a package of bills aimed at strengthening nursing home oversight in the Empire State. The move was sparked by a series of stories published by The Buffalo News on problems at local nursing homes, as well as by complaints Ortt received […]