OIG Expands Probes into Nursing Homes’ Response to COVID-19 Pandemic

The federal government’s top health care watchdog agency added a pair of new probes into the nation’s nursing homes to its already busy slate of long-term care investigations for the coming year. The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) last week rolled out two long-term care investigations — […]

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 […]

Bill Would Expand Nursing Homes’ Access to Federal Background-Check Database

A new piece of legislation before Congress would expand nursing homes’ ability to perform detailed background checks on potential employees, according to its sponsor. Sen. Kirsten Gillibrand, a New York Democrat, earlier this week announced a bill to improve health care worker hiring practices in an effort to reduce elder abuse. The initiative — known […]

OIG: Nursing Home Complaints Increase Nationwide — Along with Delays in Investigations

The federal government’s top health care watchdog logged an increase in nursing home complaints last year, according to the most recent set of data from the Department of Health and Human Services, in tandem with a 23% rise in high-priority incidents that were not investigated within the proper timeframe. The HHS Office of the Inspector […]

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 […]

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 […]

OIG Touts Nearly $3B in Medicare, Medicaid Fraud Recoveries in Fiscal 2018

The Department of Health and Human Services’ top fraud watchdog recovered nearly $3 billion from providers in fiscal 2018, a figure that included more than $18 million in improper payments at nursing homes. The HHS Office of the Inspector General (OIG) touted its $2.91 billion haul in its most recent semiannual report to Congress, released […]

Federal Lawmakers Grill CMS, HHS Over Nursing Home Safety

Representatives from the federal agencies that oversee skilled nursing agencies faced pointed questions from lawmakers on Capitol Hill on Thursday morning, with many expressing frustration with recurring resident safety issues. “We do this over and over again, but yet one-third of Medicare residents have experienced harm,” Rep. Diana DeGette, a Colorado Democrat, said during a […]

Congressmen Ask CMS to Ease Red Tape for Skilled Nursing Facilities

Two leaders of the powerful House Ways and Means Committee this week asked the Centers for Medicare & Medicaid Services (CMS) to ease regulatory burdens on skilled nursing facilities. In multiple letters to CMS administrator Seema Verma, Rep. Kevin Brady and Rep. Peter Roskam called for reduced compliance burdens for post-acute care providers, hospitals, and […]

OIG Wants to Revise Anti-Kickback Rules to Ease Care Coordination

As the federal government increasingly emphasizes care coordination among players across the health care continuum, the industry’s top watchdog signaled that it could soon overhaul its anti-kickback regulations to help providers avoid pitfalls. The Department of Health and Human Services’ Office of the Inspector General (OIG) this week published a call to providers, asking for […]

OIG Targets Hospice Services in Skilled Nursing Facilities, Recommends Cuts

When the Department of Health and Human Services’ (HHS) top watchdog arm issued an overall warning about the state of hospice care earlier this summer, skilled nursing facilities were specifically singled out as areas for improvement. The HHS Office of the Inspector General (OIG) accused hospices of using residents in nursing homes to artificially inflate […]

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 […]

Instead of Saving $1.7 Billion, ACOs Cost Medicare $384 Million

Accountable care organizations (ACOs) are supposed to represent an innovative way to cut costs and improve care. But a new study found that on at least one of those counts, ACOs may be doing more harm than good. The Medicare Shared Savings Program (MSSP) increased federal spending by $384 million between 2013 and 2016, according […]

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 […]

HHS Proposes New Payment System for Skilled Nursing Providers

The new proposed Department of Health and Human Services (HHS) budget was released on Monday, and it’s a mixed bag for skilled nursing providers. President Trump’s spending blueprint would make changes to Medicaid by creating a “market-based health-care grant” that could fund programs in addition to the traditional Medicaid program — a change that would […]

Could Trump’s Religious Objection Guidance Create SNF Turmoil?

On first glance, the Department of Health and Human Services’ new guidance on personal religious beliefs might not appear to affect the long-term care industry. Years from now, however, it could play an integral role in the way SNFs operate and staff facilities. When the government rolled out its two-pronged approach last week — establishing […]