DOJ Forms Nursing Home Task Force, Promises Criminal and Civil Penalties for Owners and Operators

The Department of Justice this week announced the creation of a specialized task force targeting “grossly substandard care” in nursing homes, with both criminal and civil penalties on the table for owners and operators. About 30 individual facilities across nine states are already under investigation, the DOJ revealed in announcing its new National Nursing Home […]

Ambulance Company Operator Given Prison Time, $750K Fine in Skilled Nursing Fraud Case

The operator of an ambulance company that primarily served nursing homes and other outpatient care sites has been sentenced to 30 months in federal prison after pleading guilty to defrauding Medicare and Medicaid. Joseph Valdie Kimble, the former operator of the Longview, Texas-based Tiger EMS, must also pay more than $750,000 in restitution to the […]

CMS Taps Anthem Vet Smith for Top Innovation, Value-Based Care Posts

The federal government on Monday announced the appointment of Brad Smith, a health care and insurance industry veteran, as the next head of the Center for Medicare & Medicaid Innovation (CMMI). Smith, previously the chief operating officer at insurance giant Anthem’s diversified business group, will additionally serve as senior advisor for value-based transformation to Department […]

Feds Sue CVS, Omnicare Over Allegations of Fraudulent Long-Term Care Pharmacy Billing

The federal government on Tuesday announced a civil lawsuit against long-term care pharmacy heavyweight Omnicare, Inc. and its parent, CVS Health (NYSE: CVS), over allegations of widespread billing fraud. The Department of Health and Human Services (HHS), through its Office of the Inspector General (OIG) watchdog arm, accused Omnicare and CVS of illegally “rolling over” […]

OIG Calls on New York to Crack Down on Nursing Home Safety

The federal government’s top health care watchdog has called on state officials in New York to beef up enforcement of nursing home safety rules after uncovering multiple violations in a recent audit. The Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) this month released a report accusing the Empire State […]

OIG: ACOs Use Three-Day Stay Waiver, Preferred Providers to Manage SNF Costs

Preferred provider networks of skilled nursing facilities, embedding staff onsite and conducting so-called “warm handoffs” were among the strategies that top accountable care organizations (ACOs) use to manage costs in the SNF and home health care setting. Because Medicare spending is expected to surpass $1.5 trillion by 2028, more than double the spending of $708 […]

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 […]