Boehler, Proponent of Post-Acute Care Bundles, to Leave Role as CMMI Chief

Adam Boehler will leave his position as the chief of the federal government’s top incubator for new payment models after an appointment to another office. President Trump late Wednesday nominated Boehler — who has served as director of the Center for Medicare & Medicaid Innovation (CMMI) since April 2018 — to become the CEO of […]

Proposed Mandatory Payment Model for Dialysis Could Have Skilled Nursing Promise

The federal government on Wednesday unveiled a new proposed payment model for certain kidney-related conditions, and several providers in the space say it could have serious potential for skilled nursing operators. Under the proposed End-Stage Renal Disease (ESRD) Treatment Choices (ETC) model, Medicare would expand coverage of care for kidney diseases and offer financial incentives […]

OIG Calls on CMS to Crack Down on Abuse in Nursing Homes, Other Settings

The federal government’s top health care watchdog on Wednesday released a new report accusing the Centers for Medicare & Medicaid Services (CMS) of not doing enough to monitor and punish elder abuse in nursing homes and other settings. The Department of Health and Human Services (HHS) determined that CMS could perform detailed analyses of diagnosis […]

HHS, DOJ Tout $2.3B in Fraud Recoveries — Including $47M from Skilled Nursing Facilities

The federal government recovered $2.3 billion in allegedly fraudulent health care reimbursements in fiscal 2018, with several big-dollar skilled nursing settlements contributing to that total. The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) last week released a joint report on their health care fraud activities for the previous fiscal […]

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 […]

Vanguard Healthcare Settles Medicare, Medicaid Fraud Claims for $18 Million

A Tennessee-based skilled nursing provider this week agreed to pay the federal government $18 million in order to resolve claims of Medicare and Medicaid fraud. Vanguard Healthcare, LLC of Brentwood, Tenn. — along with several of its affiliated firms — reached the deal with the Department of Justice, which accused the provider of providing “grossly […]

OIG Finds $84 Million in Improper Skilled Nursing Facility Payments

The federal government improperly paid skilled nursing facilities more than $84 million for services that did not meet Medicare’s three-day hospital stay requirement, according to a report released Wednesday by the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG). Medicare beneficiaries must stay in a hospital for three consecutive calendar […]

OIG: 46% of Medicare Patients in LTACs Experience Harm

Almost half of Medicare patients experience either adverse events or temporary harm events inside the walls of a long-term care hospital (LTCH) according to a November report from the Department of Health and Human Services (HHS). The Office of Inspector General (OIG) found that 21% of Medicare patients in LTCHs — also known as long-term […]

Trump Cabinet Calls on States to Eliminate Certificate of Need Laws

Three prominent members of the Trump administration called on individual states to eliminate Certificate of Need (CON) laws regarding the development of new health care facilities — including nursing homes — characterizing the statues as anti-competitive and detrimental to consumers. Writing in a sweeping, nearly 120-page report on health care reform, the secretaries of the […]

Bundled Payments Cost Medicare Nearly $300 Million

A new report on the Bundled Payments for Care Improvement (BPCI) program found that the initiative has actually resulted in Medicare losses, counter to its aims. Under BPCI, providers agree to split a set reimbursement amount for a patient’s single episode of care, with the overall goal of reducing costs across the spectrum. But in […]

Azar Touts PDPM But Warns ‘Entrenched Players’ of Challenges Ahead

Health and Human Services Secretary Alex Azar on Tuesday trumpeted the new payment model for skilled nursing facilities in a speech before a prominent trade group, positioning the plan as one piece of a larger change in the way the government pays for health care. The new Patient-Driven Payment Model (PDPM) incorporates the dual goals […]

HHS, CMS Object to Ownership Transfers in Orianna Bankruptcy

The Department of Health and Human Services (HHS) filed an objection to Orianna Health Systems’ bankruptcy plan, bringing the case into unsettled legal terrain. U.S. Attorney Erin Nealy Cox this week argued that HHS and the Centers for Medicare & Medicaid Services (CMS) have the ultimate control over the legal issues surrounding the transfer of […]

Former Long-Term Care CEO to Lead CMS Innovation Center

The Center for Medicare & Medicaid Innovation (CMMI) has a new director. Adam Boehler, founder and former chief executive officer of home health provider Landmark Health, was named CMMI director — a position that also comes with the title of deputy administrator — by Department of Health and Human Services Secretary Alex Azar. Azar has […]

OIG: More Than 60% of Therapy Claims Don’t Meet Medicare Requirements

More than 60% of outpatient therapy claims filed over a six-month period didn’t meet Medicare’s requirements — a figure that has a key government watchdog agency concerned. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) looked at a representative sample of 300 Medicare therapy claims filed in the final […]

Senators Issue Bipartisan Call to Move Away from Fee-For-Service Medicare

A pair of United States senators asked new Health and Human Services Secretary Alex Azar to focus on developing alternative payment models for Medicare — while moving away from traditional fee-for-service (FFS) Medicare. “As the largest purchaser of health care in the United States, the federal government needs to send a strong signal that paying […]

HHS Secretary Wants Providers to Take Amazon, Yelp’s Lead

If Health and Human Services secretary Alex Azar has his way, the health care consumer of the future will select providers the way they currently decide where to eat or which knockoff iPhone charger to buy. “Imagine a day when health care delivery in the United States functions the way other parts of our economy […]