Healthcare Compliance Blog

JANUARY 24, 2022

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.

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Healthcare Compliance Blog

APRIL 18, 2022

A certified nurse’s aide (CNA) who was working in an Oklahoma nursing home has pled guilty to stealing money from a resident. Our office will not tolerate the financial exploitation of our beloved nursing home residents, no matter how large or small the amount.”.

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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.

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Healthcare Compliance Blog

MAY 25, 2022

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 nursing homes that OIG previously excluded. As a result, OIG has excluded the nursing homes and their owner.

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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. Compliance and ethics. Areas with Significant Updates. Phase 3 Elements.

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MedTrainer

NOVEMBER 6, 2023

When it comes to healthcare, compliance is not just a buzzword — it’s critical to ensuring quality of care, protecting patient privacy, and staying on the right side of the law. But what exactly is a compliance plan in healthcare, and why is it so crucial? Why Is a Compliance Plan Important in Healthcare?

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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. The QSO memorandum can be accessed at: QSO-22-08-NH (cms.gov).

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MedTrainer

DECEMBER 4, 2023

Effective management of healthcare compliance in Nebraska involves careful planning and adaptability. As the state’s healthcare regulations are updated, it’s vital for organizations to maintain efficient compliance programs. Healthcare compliance means remaining current with the state’s unique regulatory requirements.

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MedTrainer

NOVEMBER 28, 2023

Managing healthcare compliance in New Jersey means adhering to a unique set of rules and standards that pose certain challenges for management teams. New Jersey’s healthcare organizations are encouraged to design thorough systems for tracking and understanding these regulations and make updates to their compliance programs as needed.

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Healthcare Law Blog

OCTOBER 27, 2022

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 nursing home 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.

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MedTrainer

SEPTEMBER 20, 2023

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, nursing homes, and pharmacies. Accreditation.

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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

MARCH 7, 2022

After an investigation into Colorado’s care for people with disabilities who reside in nursing homes, 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.

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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

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Hall Render

JANUARY 18, 2022

Amidst a nationwide nursing and skilled nursing facility staffing crisis, the Centers for Medicare & Medicaid Services (“CMS”) announced that additional information regarding nursing home staff numbers will be added to the January 2022 CMS Care Compare website. Weekend Staff.

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MedTrainer

MAY 4, 2023

That includes many compliance professionals. There are plenty of compliance implications for the end of the Public Health Emergency on May 11, 2023 , and an assessment is a great place to start. Nursing homes must still provide annual emergency preparedness training. Hard to believe, huh?

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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 NA HPRD requirements, a total nurse staffing standard should be required.

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Provider Trust

AUGUST 9, 2023

Through collaborative efforts with partners such as the Department of Justice (DOJ), Medicaid Fraud Control Units (MFCUs), and various federal, state, and local law enforcement agencies, the OIG employs a comprehensive and data-driven approach to detect, investigate, and prosecute instances of fraud.

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MedTrainer

OCTOBER 27, 2020

Keys to managing Point-of-Care Testing Compliance. 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. HHS argued antigen testing is the best option available.

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Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

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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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Hall Render

FEBRUARY 27, 2023

Health Care Fraud Actions Medicaid. The Medicaid program was a target in 2022. DOJ recovered $260 million from a pharmaceutical company for its underpayment of rebates to the Medicaid program by improperly designating one product as a new drug. Hall Render blog posts and articles are intended for informational purposes only.

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Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

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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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Healthcare Law Blog

DECEMBER 19, 2022

In 2021, COVID-19 immunization rates among nursing home staff quickly rose due to federal vaccine mandates for healthcare workers and long-term care facilities participating in the Federal Pharmacy Partnership for Long-Term Care Program. viii] Who We Help – Nursing Homes | qioprogram.org. pdf (federalregister.gov).

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Healthcare Compliance Blog

JANUARY 10, 2022

A South Carolina man has been arrested for financial transaction card fraud and exploitation of a vulnerable adult who was a resident of a nursing home. He then used the debit card to make unlawful and unauthorized use of the victim’s funds or assets, which exceeded $500 within a six-month period.

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Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. The woman, 45, pleaded guilty to an amended charge of Reckless Conduct (Class A Misdemeanor).

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Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

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YouCompli

JANUARY 4, 2022

Unger, Chief of Medicaid Fraud Division, Office of the Massachusetts Attorney General; and Patrick Callahan, Healthcare Fraud Unit, US Attorney’s Office. Unger and Callahan addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. Provider workload and compliance.

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Bill of Health

SEPTEMBER 9, 2022

patchwork ” system of incarceration, ultimately fall far short of the extensive regulatory framework governing Medicare/Medicaid, which shapes health care for over 83 million people in the U.S. health law and policy is the exclusion of people in custody in prisons, jails, and detention centers from Medicaid.

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Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”). Your primary Hall Render contact.

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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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AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

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AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

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Hall Render

JANUARY 31, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has armed surveyors with detailed instructions on how to survey skilled nursing facilities for compliance with the CMS staff vaccine requirements. Hall Render blog posts and articles are intended for informational purposes only. Your regular Hall Render attorney.

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Healthcare Compliance Blog

JUNE 8, 2022

A Maine nursing home 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 nursing home, so police took her to the facility. In the second case, the resident was hit and killed by a motor vehicle.

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Hall Render

JULY 12, 2023

Selection Approach In establishing the proposed SFP, CMS examined the Special Focus Facility program for nursing homes and its methodology for facility selection. Hall Render blog posts and articles are intended for informational purposes only. CMS’ goal is to select SFP hospices starting in 2024. Markette, Jr.,

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