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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.
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.
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.
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.)
As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.
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.,
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)
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.,
In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursinghome knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. Attorney Kurt R.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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 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
The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.
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.
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.
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.
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 Medicaid Fraud Division also prioritizes the physical and financial security of residents who reside in Massachusetts nursinghomes. Cases include: In September 2021, a certified nurse’s aide was charged with sexually assaulting two elderly nursinghome residents at a Massachusetts nursinghome while he worked the night shift.
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).
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.
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.
Last week, CMS proposed increases in Medicare rates for certain health care services, and Florida’s governor signed legislation that ensures patients of hospitals and health care facilities are allowed to have visitors. In other news, a large committee of experts issued a report on the nursinghome industry that was less than flattering.
Leveraging Oversight To Protect NursingHome Residents Better Enhancing the quality of care in nursinghomes remains paramount to OIG. Through years of oversight, they have discovered various obstacles and weaknesses within nursinghome facilities.
According to a recent study , physician-owned hospitals treated some of the most expensive Medicare beneficiaries at significantly lower costs compared to traditional hospitals, despite serving similar patient populations. In the broader nursinghome industry, 19% meet such minimum staffing benchmarks.
On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D.,
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