OIG Launches Investigation into Skilled Nursing Residents With Potentially Preventable Hospitalizations

The Department of Health and Human Services’ (HHS) watchdog arm added a probe of skilled nursing residents who had potentially preventable hospitalizations in its list of priorities over the next year. The HHS Office of the Inspector General (OIG) recently announced an additional investigation as part of its 2022 work plan — specifically focusing its […]

OIG: CMS Needs to Keep Closer Eye on MA Plans Denying Requests for SNF Care

The Department of Health and Human Services’ top watchdog arm has raised concerns over some Medicare Advantage plans that have denied certain services requested by patients, including those trying to get skilled nursing care. MA plans issue millions of denials each year and the HHS Office of the Inspector General (OIG) found widespread and persistent […]

Ancillary Services More Important Than Ever, But Still Risky Path for Skilled Nursing Operators

One way skilled nursing facilities have looked to diversify and evolve post-COVID is by adding ancillary services in-house, such as home health or pharmacy. But as Alan Schabes, partner at Benesch, Friedlander, Coplan & Aronoff LLP, warned, getting into ancillaries for the wrong reasons can be a dangerous path for nursing home operators. “If you […]

CMS To Post Nursing Home Weekend Staffing, Staff Turnover Data

As staffing shortages continue to grip providers across the country, the Centers for Medicare & Medicaid Services (CMS) announced last week that it will put measures in place to establish better transparency on staffing levels at nursing homes moving forward. Numbers on staffing turnover and weekend staffing levels for nursing homes will start getting posted […]

71% of Nursing Homes Have Gone 16 Months Without Standard Survey

Out of 15,295 nursing homes nationally, 10,913, or 71%, have gone at least 16 months without a standard survey as of May 31, according to an updated report filed by the U.S. Department of Health and Human Services Office of Inspector General.  The report suggests that the Centers for Medicare and Medicaid issue guidance for […]

OIG: Nursing Home Deaths Jumped 32% in 2020

A new report studying nursing home populations during the pandemic shows that four in 10 Medicare recipients in nursing homes had or likely had COVID-19 in 2020. The report additionally found that deaths overall jumped by 32% compared to 2019. The report, conducted by the U.S. Department of Health and Human Services (HHS), is part […]

Nursing Home Management Firm CareOne Pays $700K to Settle False Claims Act Allegations

A management company that provided financial back-office services to health care facilities agreed to pay $714,996 to resolve allegations that it violated the False Claims Act — specifically related to claims for reimbursement of Medicare bad debt — acting U.S. attorney Rachael A. Honig announced this week. The federal government through the U.S. Department of […]

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 […]

Abuse Reporting and Owner Background Checks Loom Large in Elder Justice Hearing

Background checks for staff and better reporting for nursing home abuse loomed large in a U.S. Senate Committee on Finance hearing held Tuesday, with consumer advocates and industry representatives confirming the findings of a new report that revealed oversight gaps by the Centers for Medicare & Medicaid Services (CMS) around nursing home abuse. The report, […]

OIG Clears Nursing Home with 93% Very High, Ultra-High Therapy After Review

In an unusual outcome, the federal government’s top health care watchdog arm publicly cleared a nursing home it suspected of providing unnecessarily intensive therapy services. The Department of Health and Human Services (HHS) this week determined that the skilled nursing facility at an Oklahoma continuing care retirement community (CCRC) properly supported all its therapy minutes […]

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 […]

Iowa Sen. Presses CMS Over Abuse Protections for Skilled Nursing Residents

Sen. Chuck Grassley, an Iowa Republican, joined a growing chorus by questioning whether the Centers for Medicare & Medicaid Services (CMS) is doing enough to protect skilled nursing residents from abuse. In a letter penned last Friday, Grassley pressed CMS on “why it has failed to ensure that nursing home abuse and neglect cases are reported to law […]

OIG Audit Reveals Inadequate Abuse Protections for Skilled Nursing Residents

Abuses at skilled nursing facilities frequently go unreported, the Department of Health and Human Services (HHS) determined in a new report that also accused the Centers for Medicare & Medicaid Services (CMS) of not doing enough to protect residents. HHS’s Office of the Inspector General (OIG) reviewed the emergency room records for 134 Medicare beneficiaries with any […]