Med-Net Compliance

NOVEMBER 8, 2022

On November 3, 2022, the OIG released the results of a recent inspection of a nursing home by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections). Train appropriate staff to accurately document and report direct care hours worked. Update your policies as needed.

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Nursing Homes Nurses US Department of Health and Human Services Licensing 59

Med-Net Compliance

AUGUST 3, 2022

A Pennsylvania nursing home will pay $819,640 to settle claims that it provided medically unnecessary rehabilitation therapy to residents to maximize revenue, and without prioritizing clinical needs. overbilled federal healthcare programs such as Medicare for therapy services provided; (b)?billed

Nursing Homes 59

Nursing Homes Nurses Medicare Medicare 59

Hall Render

MARCH 4, 2025

Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community. Medical Directors in Nursing Homes 42 CFR 483.70(g)

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Compliance Nursing Homes Nurses Medicare 52

Med-Net Compliance

AUGUST 18, 2022

An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. to the United States.

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Nursing Homes US Department of Health and Human Services Nurses Medicare 59

Healthcare Compliance Blog

JANUARY 18, 2022

On January 7, 2022, the Centers for Medicare & Medicaid Services (CMS) published a memorandum stating that nursing home staff turnover and weekend staffing will be posted on the Medicare.gov Care Compare public website. Document that these trainings occurred and file in each appropriate employee’s education file.

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Nursing Homes Nurses Medicaid Medicaid 59

Med-Net Compliance

AUGUST 1, 2022

The Centers for Medicare & Medicaid Services launched its enhanced Nursing Home Five-Star Quality Rating System which integrates data nursing homes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators. Ratings are updated quarterly.

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Nursing Homes Nurses Licensing Medicaid 59

Hall Render

FEBRUARY 4, 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 nursing homes regarding the role of the medical director and how mental disorders are diagnosed. ruled out) the effects of a substance (e.g.,

Nursing Homes 52

Nursing Homes Nurses Compliance Medicaid 52

Hall Render

FEBRUARY 25, 2025

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.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicaid 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

The United States has filed a lawsuit against an Alabama psychiatrist for improper prescribing of Nuedexta to nursing home 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.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

Healthcare Law Blog

SEPTEMBER 6, 2023

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

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Hall Render

AUGUST 21, 2023

Nursing homes are critical in providing residents with care, comfort and dignity. Nursing homes need to navigate this delicate terrain with care, sensitivity and a commitment to creating a safe and respectful environment for all residents.

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Nursing Homes Nurses Medicaid Medicaid 40

MedTrainer

SEPTEMBER 20, 2023

Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

Healthcare Compliance Blog

APRIL 14, 2022

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.

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Medicare Medicare Overpayment Overpayments 59

Hall Render

JUNE 30, 2022

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 nursing homes regarding the quality of care and quality of life for residents.

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Nursing Homes Nurses Compliance Licensing 40

Healthcare IT News - Telehealth

APRIL 24, 2020

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.

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Telemedicine COVID-19 Medicaid Medicaid 198

Hall Render

MAY 2, 2023

For this alert, “nursing homes” refers to skilled nursing facilities (often known as “SNFs”). In 2020, CMS revised the nursing home infection control regulations at 42 CFR § 483.80 Additionally, this information is now publicly available on CMS’s COVID Nursing Home Data Website.

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Healthcare Compliance Blog

MAY 18, 2022

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).

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Nursing Homes Nurses Medicaid Medicaid 59

Hall Render

JULY 5, 2023

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.

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Nursing Homes Nurses Hospitals Medicaid 40

Med-Net Compliance

JULY 26, 2022

Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes. In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds.

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Fraud Telemedicine Medicare Medicare 59

Healthcare Law Blog

DECEMBER 19, 2022

Facilities are reminded that they must keep documentation tracking (i) the educational resources offered and (ii) whether the resident or their representative accepted or refused the vaccine. viii] Who We Help – Nursing Homes | qioprogram.org. Education for Staff Regarding Up-To-Date Vaccinations and Boosters. vi] [link].

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COVID-19 Vaccine COVID-19 Nursing Homes Nurses 52

Hall Render

SEPTEMBER 6, 2023

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 (“nursing homes”). Nursing homes would need to provide residents with a minimum of 0.55 HPRD for RNs and 2.45

Nursing Homes 40

Nursing Homes Nurses Medicaid Medicaid 40

MedTrainer

OCTOBER 27, 2020

Keys to managing point-of-care testing complianceIn an effort to combat the spread of the virus and to help nursing homes protect the health and safety of their residents, the U.S. To be eligible, nursing homes must have a current CLIA Certificate of Waiver and meet certain epidemiological criteria.

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Compliance Nursing Homes COVID-19 Nurses 40

MedTrainer

OCTOBER 27, 2020

In an effort to combat the spread of the virus and to help nursing homes protect the health and safety of their residents, the U.S. To be eligible, nursing homes must have a current CLIA Certificate of Waiver and meet certain epidemiological criteria. HHS argued antigen testing is the best option available.

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Compliance Nursing Homes COVID-19 Nurses 40

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

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Compliance Officers Compliance Medicare Medicare 52

New Jersey Healthcare Blog

NOVEMBER 8, 2022

In October 2022, Centers for Medicare & Medicaid Services (CMS) made some significant changes to the Special Focus Facility (SFF) program that raise the bar for completion of the program and that increases enforcement actions for nursing homes that fail to demonstrate improvement. See 42 U.S.C. §§ 1819(f)(8), 1919(f)(1).

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Nursing Homes Nurses Medicaid Medicaid 40

Med-Net Compliance

JULY 25, 2022

A Massachusetts nursing home failed to provide an individual’s personal representative with timely access to her son’s medical records. Document that these trainings occurred and file the signed training document in the employee’s education file.

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HIPAA US Department of Health and Human Services Nursing Homes Nurses 59

Healthcare Law Blog

AUGUST 25, 2023

Medicare and Medicaid). Errors that require formal corrective action plans should always be self-disclosed using the “Self-Disclosure Full Statement,” while errors that are more transactional or routine in nature and already repaid through voids or adjustments may be better suited to the new “Self-Disclosure Abbreviated Statement.” [2]

Overpayments 52

Overpayments Overpayment Medicaid Medicaid 52

Hall Render

DECEMBER 3, 2024

The Centers for Medicare & Medicaid Services (“CMS”) provided additional details and information related to CMS provider enrollment site visits. A site visit is intended to prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program.

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Medicare Medicare Nursing Homes Medicaid 40

Hall Render

JANUARY 17, 2025

This CMS fact sheet is the only blanket waiver that exists for skilled nursing, home health agencies, critical access hospitals, durable medical equipment and other providers. k), allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. a)(2) and Section 484.55(b)(3)

Nursing Homes 40

Nursing Homes Nurses Public Health Medicare 40

MedTrainer

NOVEMBER 6, 2023

While specific compliance requirements vary depending on the type of facility — from large hospitals and surgery centers to clinics and nursing homes — having a well-structured compliance plan is essential for all medical settings. Establishing documented rules, processes, and behavioral guidelines 2. They are: 1.

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Compliance Fraud Nursing Homes Governance 52

Hall Render

JANUARY 6, 2022

Nursing homes face possible citations, civil monetary penalties, denial of payments and—as a final measure—termination of participation from the Medicare and Medicaid programs by the Centers for Medicare & Medicaid Services (“CMS”) as they embark on complying with the new CMS COVID-19 vaccine requirements for their staff.

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COVID-19 Vaccine COVID-19 Nurses Compliance 40

Health Law Advisor

APRIL 8, 2022

On April 7, 2022, the Centers for Medicare and Medicaid Services (CMS) issued guidance terminating numerous blanket waivers applicable to skilled nursing facilities (SNFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end stage renal disease (ESRD) facilities.

COVID-19 52

COVID-19 Nurses Nursing Homes Medicaid 52

YouCompli

JANUARY 4, 2022

Unger reported that her unit is focused on about 65% Medicare fraud and about 35% abuse and neglect. When people defraud the system they don’t just defraud Medicaid, they also get Medicare and private insurance. To access the full session recording, please contact the Massachusetts Health and Hospital Association.

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Healthcare Law Blog

JUNE 22, 2023

The preliminary list will be available for public comment for at least 30 days in which a manufacturer will be allowed to provide documentation to establish that the costs did not exceed the limits above. If established, the drug will be removed from the list prior to publication.

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Hospitals Nursing Homes Health Insurance Public Health 52

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Under 42 CFR Sec.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Med-Net Compliance

AUGUST 4, 2022

The Office of Inspector General (OIG) conducted an audit and found that selected nursing homes may not have complied with federal requirements for infection prevention and control and emergency preparedness. Specifically, 28 of 39 nursing homes they audited had possible deficiencies.

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Nursing Homes Nurses COVID-19 Medicaid 59

Bill of Health

MARCH 16, 2022

spread between nursing homes. These facilities, like most nursing homes, are for-profit businesses that pad their margins by cutting labor costs. In theory, all this care could be delivered in seniors’ homes and communities. Recall that the first COVID-19 outbreak in the U.S.

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