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The Centers for Medicare & Medicaid Services (CMS) has given surveyors additional rules and updates to allow surveyors to assess and cite violations of the regulations on nursinghomes with admission agreements that create prohibited third-party guarantee of resident payments.
On March 7, 2025, the Centers for Medicare & Medicaid Services (CMS) posted a memo dated March 10, 2025, that gives nursinghomes and surveyors more time to prepare for implementation of new rules and updates to allow surveyors to add extra attention and increase oversight in nursinghomes.
In 2023, nursinghomes have seen increased citations by surveyors for noncompliance tied to their pre-dispute, binding agreements for binding arbitration with their residents. The Arbitration Regulations revised the requirements for arbitration agreements when they are used by nursinghomes to resolve disputes with their residents.
A New York optician has pled guilty to grand larceny for submitting false claims for optician services that he alleged were for specific nursinghome residents, but which were never provided. Additionally, it is necessary that the billing office ensures that no double billing occurs by the nursinghome and any consultant.
According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. Hall Render blog posts and articles are intended for informational purposes only.
More > Tags: Centers for Medicare & Medicaid Services , Civil Penalties , CMS , Healthcare Providers , Long-Term Care , Long-Term Care Facilities , Medicare. For reference, the 2017 Guidance can be found here. The accompanying CMP Analytic Tool can be found here.)
A certified nurse’s aide (CNA) who was working in an Oklahoma nursinghome has pled guilty to stealing money from a resident. Our office will not tolerate the financial exploitation of our beloved nursinghome residents, no matter how large or small the amount.”.
On January 7, 2022, the Centers for Medicare & Medicaid Services (CMS) published a memorandum stating that nursinghome staff turnover and weekend staffing will be posted on the Medicare.gov Care Compare public website. The QSO memorandum can be accessed at: QSO-22-08-NH (cms.gov).
On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursinghome facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has excluded a Louisiana man from participation in federal healthcare programs due to his ownership interest in seven Louisiana nursinghomes that OIG previously excluded. As a result, OIG has excluded the nursinghomes and their owner.
Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursinghome members of the health care compliance community. Medical Directors in NursingHomes 42 CFR 483.70(g)
A Maine nursinghome with a history of federal fines was listed as a special focus facility (SFF) after two residents wandered off in separate incidents last year. They were one mile from the nursinghome, so police took her to the facility. In the second case, the resident was hit and killed by a motor vehicle.
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
The Centers for Medicare & Medicaid Services (“CMS”) is reinforcing regulatory expectations regarding nursinghome residents’ rights to vote. On September 26, 2024, CMS issued a QSO Memo , “Compliance with Residents’ Rights requirement related to NursingHome Residents’ Right to Vote.” 42 CFR §483.10(b)(1)
Department of Health and Human Services found that most skilled nursing facilities (“nursinghomes”) in Massachusetts that it surveyed are not correctly complying with life safety requirements or emergency preparedness requirements. The Office of Inspector General (“OIG”) of the U.S.
On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.
Department of Health and Human Services found that most skilled nursing facilities (“nursinghomes”) in Georgia that it surveyed are not correctly complying with life safety requirements or emergency preparedness requirements. The Office of Inspector General (“OIG”) of the U.S.
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
After an investigation into Colorado’s care for people with disabilities who reside in nursinghomes, the Department of Justice (DOJ) concluded that the state unnecessarily segregates people with physical disabilities in nursing facilities. Interview residents to ensure that all safe discharge planning needs have been met.
Hall Render blog posts and articles are intended for informational purposes only. The post NursingHome Update: CMS Confirms Acute Respiratory Illness Reporting Requirements appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.
Department of Justice (DOJ) announced it has sued three nursinghomes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S.
Department of Justice (DOJ) announced it has sued three nursinghomes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S.
The United States has filed a lawsuit against an Alabama psychiatrist for improper prescribing of Nuedexta to nursinghome residents. The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta.
As nursinghomes look for funds to allow them to improve care and train nursinghome staff, Centers for Medicare & Medicaid Services (“CMS”) released QSO-23-23-NH (“CMS Memo”), which reopens and recasts the Civil Money Penalty Reinvestment Program (“CMPRP”).
The Centers for Medicare & Medicaid Services (CMS) has given surveyors new rules and updates to allow surveyors to assess and cite violations of the regulations on resident discharge and transfer. Hall Render blog posts and articles are intended for informational purposes only.
The Centers for Medicare & Medicaid Services (CMS) has given surveyors new rules and updates to allow surveyors to add extra attention and increase oversight in nursinghomes regarding the role of the medical director and how mental disorders are diagnosed.
The COVID data reporting through the National Healthcare Safety Network (“NHSN”) was first required of nursinghomes in May 2020 through an interim final rule. CMS took regulatory action through the Calendar Year 2022 Home Health Prospective Payment System rule to extend those requirements through December 31, 2024.
Nursinghomes are critical in providing residents with care, comfort and dignity. Nursinghomes need to navigate this delicate terrain with care, sensitivity and a commitment to creating a safe and respectful environment for all residents.
AHCA is sending out postcards to existing Florida Medicaid providers (Providers) alerting them to upcoming changes in the Florida Medicaid program. Providers are urged to sign into their account on the Florida Medicaid portal immediately. Medicaid Certified School Match Program Fee Schedule. Check your mailboxes.
Leveraging Oversight to Better Protect NursingHomes – In the introduction to this Semiannual Report, Grimm indicated that “providing quality and safety of care in the more than 15,000 Medicare- and Medicaid-certified nursinghomes nationwide” is a “top priority” moving forward. FOOTNOTES. [1]
The Centers for Medicare & Medicaid Services (“CMS”) has given surveyors new rules and updates to allow surveyors to add extra attention and increase oversight in nursinghomes regarding the quality of care and quality of life for residents. Hall Render blog posts and articles are intended for informational purposes only.
Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursinghomes, and pharmacies. There are a number of laws built to fight against Medicare/Medicaid noncompliance and fraud. Accreditation.
On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.
On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities. [1] Nurse Aide (NA) HPRD (the “2.45 Nurse Aide (NA) HPRD (the “2.45 55 RN hours per resident per day (the “.55 55 RN HPRD”); and At least 2.45
On November 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance under QSO-25-09-ALL, updating Core Appendix Q of the State Operations Manual regarding findings of immediate jeopardy. Hall Render blog posts and articles are intended for informational purposes only.
In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 CMS and subject matter experts created the Hand in Hand in-service training for nurse aides to meet this requirement. Medicaid training requirements can even vary across the specific payment models within Medicaid.
Facing further confusion from skilled nursing facilities and families amidst the current spike in COVID cases in the United States, the Centers for Medicare & Medicaid Services (“CMS”) released additional best practices and addressed more issues that skilled nursing providers should follow as they encounter certain visitation scenarios.
For this alert, “nursinghomes” refers to skilled nursing facilities (often known as “SNFs”). In 2020, CMS revised the nursinghome infection control regulations at 42 CFR § 483.80 Additionally, this information is now publicly available on CMS’s COVID NursingHome Data Website.
When a patient is discharged from acute care, it is important that the acute care provider deliver accurate and appropriate patient information related to a patient’s treatment and condition in order to decrease the risk of readmission or an adverse event at the skilled nursing providers and home health agencies.
The Centers for Medicare and Medicaid Services (“ CMS ”) has also taken recent action to implement a COVID-19 vaccine mandate. In November 2021, CMS issued an Interim Final Rule (“ IFR ”) that would require facilities receiving Medicare and Medicaid funding to ensure that their staff are vaccinated against COVID-19.
The program is funded by the Centers for Medicare & Medicaid Services (CMS), and will establish a Center of Excellence for Building Capacity in Nursing Facilities to Care for Residents with Behavioral Health Conditions (Center for Excellence).
In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them. NursingHomes: Skilled nursing facilities, long-term care facilities, and other types of nursinghomes.
On September 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that calls for minimum staffing standards in long-term care facilities (“nursinghomes”). Nursinghomes would need to provide residents with a minimum of 0.55 HPRD for RNs and 2.45
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