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 — […]

OIG Launches Multiple Investigations into Nursing Home Response to COVID-19

The Department of Health and Human Services’ (HHS) watchdog arm added multiple probes of nursing homes’ response to COVID-19 to its list of top 2020 priorities, with a particular focus on infection control. The HHS Office of the Inspector General (OIG) last Friday announced two coronavirus-related investigations as part of its ongoing 2020 Work Plan […]

Encore Rehabilitation, DOJ Reach $4M Settlement in False Claims Act Case

Encore Rehabilitation Services on Friday publicly agreed to pay $4 million to settle federal allegations that the contract rehab provider violated the False Claims Act. The Department of Justice had accused the Farmington Hills, Mich.-based rehab operator of “causing three Michigan skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that […]

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 […]

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: 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 […]

‘CMS is Watching’: Changing Therapy Patterns Raise Concerns About Skilled Nursing Audits, Care Quality

The first week of the new Medicare payment model for nursing homes has brought stories of rapidly shifting therapy patterns among some providers, and voices from the consulting and advocacy worlds are warning that any sudden movements could cause adverse effects — both immediately and down the road. The advent of the Patient-Driven Payment Model […]

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 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 […]

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: 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 […]

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 […]

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 […]