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
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 […]
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 […]
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 […]
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 […]
A federal judge this week ordered that a long-running lawsuit against the government over Medicare skilled nursing benefits must go to trial, citing the very real risk that residents have been wrongly denied coverage. U.S. District Judge Michael Shea rejected the Department of Health and Human Services’ (HHS) request to dismiss the class action suit, […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
As the skilled nursing industry prepares for a shift away from therapy as a primary reimbursement driver, a new study raises questions about the use of high-intensity therapy minutes at the end of residents’ lives. Between 2012 and 2016, ultra-high rehabilitation services provided to nursing home residents in their final month of life spiked 65%, […]
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 […]
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 […]
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 […]
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 […]
A group of 12 Democratic U.S. senators slammed the Centers for Medicare & Medicaid Services in a letter sent last week, claiming that its leadership’s decision to ease regulatory restrictions on nursing homes has put seniors in danger. “We write with deep concern over a string of actions by the Centers for Medicare & Medicaid […]
Accountable care organizations (ACOs) are built on a basic premise: By working together, providers across the health care continuum can save Medicare money and boost quality. But the largest share of the savings may simply come from shifting patients out of skilled nursing and home health settings, a new study suggests — and not on […]
Skilled nursing operators can breathe a little easier as the second phase of the new Requirements for Participation takes effect this week: The Centers for Medicare & Medicaid Services (CMS) has delayed penalties for several of the new requirements. For the next 18 months, CMS won’t take enforcement action — in the form of civil […]
Subscribe
Receive industry updates and breaking news from SNN.