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Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. Last November, the OIG published industry-specific compliance guidance for 2024 for several healthcare subsectors, including nursinghomes and facilities.
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) See 42 C.F.R.
My commitment to this work has led me to build innovative programs both in the community and in skilled nursing facilities, designed to provide more and better-focused care to our frail elderly. According to Bureau of Labor Statistics data 1 , the number of workers employed at nursing care facilities nationwide has declined by 15%—from 1.59
The Office of Inspector General (OIG) released an updated Nursing Facility Industry Compliance Program Guidance (ICPG) in November 2024 to assist nursing facilities in navigating the complex regulatory landscape and mitigating compliance risks. The ICP covers the areas listed below.
American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education to physicians. American Medical Compliance designates this activity for a maximum of 0.5 To become certified, please visit us at: American Medical Compliance (AMC).
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.
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.
The HHS Office for Civil Rights announced on Tuesday that during the coronavirus pandemic it will use discretion when enforcing HIPAA-compliance for telehealth communications tools. WHY IT MATTERS. and Google G Suite Hangouts Meet. THE LARGER TREND. ON THE RECORD.
"The FCC COVID-19 Telehealth Program will enable Parker to reduce patient face-to-face encounters in the nursinghome and the possible impact of COVID-19, reduce PPE, and minimize staff burden." " Lorraine Breuer, Parker Jewish Institute for Health Care and Rehabilitation. ” MARKETPLACE.
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.
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.
According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursinghome residents in Chicago and surrounding areas.
It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024.
In recent months, there has been a lot of attention on decisions made during the height of the COVID-19 pandemic in New York State in regard to nursinghomes. Nursinghome operators themselves have faced suspicion in regard to such readmissions. Such funds will be used to support the NursingHome Quality Pool.
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.
On November 3, 2022, the OIG released the results of a recent inspection of a nursinghome by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections).
An Oklahoma nurse aide pleaded guilty to abusing a nursinghome resident and was placed on a deferred sentence probation for three years under the supervision of the Oklahoma Department of Corrections. toward the cost of the investigation to the Office of the Attorney General Medicaid Fraud Control Unit (MFCU), $300.00
The Office of Inspector General (OIG) conducted an audit and found that selected nursinghomes may not have complied with federal requirements for infection prevention and control and emergency preparedness. Specifically, 28 of 39 nursinghomes they audited had possible deficiencies.
An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.?Under Train all staff on your compliance and ethics policies and procedures upon hire and at least annually.
They identified that 6,622 nursinghomes had been cited for infection prevention and control program deficiencies as of February 26, 2020, and Medicare.gov indicated that 24 nursinghomes were part of a nursinghome chain. The OIG’s audit found that 23 of the 24 nursinghomes had possible deficiencies.
On September 23, 2022, the Centers for Medicare & Medicaid Services (CMS) issued revised COVID-19 nursinghome visitation guidance. Nursinghomes should use the community transmission level metric, not the community level metric. The revision provides updated guidance for face coverings and masks during visits.
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.”.
The evidence at the trial showed that the CNA performed an improper, one-person lift of a nursinghome resident which resulted in severe and painful injuries to the resident. I want to thank the Medicaid Fraud Control Unit for thoroughly investigating this crime and successfully pursuing justice.
The Centers for Medicare & Medicaid Services launched its enhanced NursingHome Five-Star Quality Rating System which integrates data nursinghomes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators. Ratings are updated quarterly.
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.
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 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.
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. This includes a physicians order and a detailed explanation of why the facility can no longer meet the residents needs.
Medicare and Medicaid certified facilities will be required to ensure that their employees are vaccinated for COVID-19, the Centers for Medicare & Medicaid Services (CMS) announced on September 9, 2021. The Interim Final Rule will apply to any healthcare facility receiving Medicare or Medicaid reimbursement. The OSHA ETS.
In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Why Additional Training Is Required for Medicare-Enrolled Providers Training helps providers understand and adhere to Medicare’s complex regulations and guidelines, essential for maintaining compliance.
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)
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.
The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has announced that they will be enhancing their focus on potentially preventable hospitalizations of Medicare-eligible skilled nursing facility (SNF) residents. Audit resident care plans to ensure they are regularly followed and updated as needed.
The Alliance for Integrated Care of New York (AICNY) oversees the healthcare needs of roughly 6,200 dually eligible Medicare and Medicaid beneficiaries with intellectual and developmental disabilities (IDD). Many AICNY beneficiaries reside in group homes and use Federally Qualified Community Health Centers. THE PROBLEM. MARKETPLACE.
In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.
What types of healthcare facilities are required by the government to have a compliance program? 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.
Appendix PP Update Planned In the Memo, CMS announced that it will develop guidance for surveyors to evaluate compliance with the new acute respiratory illness reporting requirements and provide information on enforcement actions for noncompliance. The Final Rule was published on November 7, 2024, with an effective date of January 1, 2025.
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. current DSM criteria) for the diagnosis.
Over the years, while digital technology was quickly advancing, telehealth had a relatively low adoption rate due to poor reimbursement rates and regulatory challenges when it came to patient privacy and HIPAA compliance. This means patients can receive care wherever they are – at home, nursinghome, assisted living, etc.
Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. 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. Accreditation.
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”).
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 NA HPRD requirements, a total nurse staffing standard should be required.
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. Compliance and ethics. Areas with Significant Updates. Phase 3 Elements.
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