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Showing 21 posts in Long Term Care.

MDHHS Issues New Guidelines for Programs of All-Inclusive Care for the Elderly (PACE) Organizations in Michigan

Programs of All-Inclusive Care for the Elderly (PACE) organizations provide certain medical and social services to eligible individuals who meet the Long Term Care level of care criteria. Read More ›

Categories: Long Term Care, Medicare/Medicaid

OIG Report Could Trigger Increased CMS Oversight of Skilled Nursing Facilities

The U.S. Department of Health & Human Services ("HHS") Office of Inspector General ("OIG") recently issued a preliminary report regarding quality of care concerns at skilled nursing facilities ("SNFs"). The report was issued in connection with the OIG's ongoing review of potential abuse and neglect of Medicare beneficiaries in SNFs. Read More ›

Categories: Long Term Care, Medicare/Medicaid

CMS Delays Enforcement of Nursing Home Mega Rule

Mega Rule Enforcement DelayedThe Centers for Medicare & Medicaid Services ("CMS") recently announced that they will delay enforcement penalties related to Phase 2 of their revised nursing home Requirements for Participation (commonly referred to in the industry as the "Mega Rule"). Read More ›

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Providers

HHS OIG Report Identifies Non-Compliance in Hospice Documentation

MedicareHospice care is intended to help terminally ill beneficiaries continue living with minimal disruptions and to provide support for a beneficiary’s family and caregivers. In a recent report, the Department of Health and Human Services Office of Inspector General (OIG) found that hospices are not always meeting two key coverage requirements for the Medicare hospice benefit: (1) that beneficiaries sign an election statement and (2) that a physician certifies that the beneficiary is terminally ill. The purpose of these requirements is, among other things, to properly inform beneficiaries of the implications of hospice care and to prevent Medicare fraud. Read More ›

Categories: Long Term Care, Medicare/Medicaid

CMS Announces New Conditions of Participation for Long-Term Care Facilities

Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.

LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three. Read More ›

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Pharmacy, Providers

CMS Proposes Rule to Update Wage Index and Payment Rate for the Medicare Hospice Benefit

medicare hospice benefitOn April 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule that would update fiscal year (“FY”) 2016 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries (the “Proposed Rule”). CMS estimates that the Proposed Rule would result in a 1.3 percent ($200 million) increase in hospice payments for FY 2016. The highlights of the Proposed Rule are summarized below.  Read More ›

Categories: Billing/Payment, Long Term Care, Medicare/Medicaid, News & Events

New Laws Expand Powers and Responsibilities of Guardians Relating to DNR Orders

DNR ordersOn Feb. 4, 2014, new legislation took effect amending Michigan's Do-Not-Resuscitate Procedure Act (the "Act").The Act allows a guardian, who has the power under Michigan’s guardianship laws, to consent to a do-not-resuscitate order (“DNR Order”) on behalf of a legally incapacitated person under certain conditions. This power does not extend to a guardian ad litem.

In 1996, Michigan passed the Act, which permits a competent adult or his or her patient advocate to sign a DNR Order instructing emergency personnel not to perform potentially life-saving procedures in the event of the cessation of respiration and circulation. However, the Act did not give express authority to a guardian acting on behalf of an individual to authorize a DNR Order. Read More ›

Categories: Compliance, Hospitals, Long Term Care

Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes

Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.

The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Long Term Care, Medicare/Medicaid, Pharmacy, Providers

NPDB Guide for Reporting Clinical Privileges Actions

Guide thumbnailThe National Practitioner Data Bank (NPDB) has published a quick guide to assist hospitals and health care entities in reporting actions that adversely affect clinical privileges held by physicians, dentists and other health professionals.

The guide (We have identified that the following link is no longer active, and it has been removed) lists several “reporting scenarios” and indicates the type of report that may be required (initial adverse action report, revision-to-action report, correction report, or no report). The guide also summarizes the reasons for voiding a previous report (report was erroneously submitted, action was not reportable, or action was reversed or overturned).

The guide is a helpful starting point for a hospital or health care entity that is involved in a privileging action. However, the scope and timing of reporting requirements under the NPDB regulations can be quite complex. Considering the very serious implications from reporting—or not reporting—an adverse privileging action, it would be prudent to only use the guide as a quick reference and not as a decision-making tool.

If you have any questions about the guide, please contact Richard Kraus at 517.371.8104 or by using the email form below.

Categories: Hospitals, Long Term Care, Physicians

Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud

medicare fraudSo far, July has been a busy month for health care fraud enforcement across the country.

On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›

Categories: Fraud & Abuse, Health Care Reform, Hospitals, Long Term Care, Medicare/Medicaid, Physicians