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 […]