South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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Happy 50th Birthday to Medicare and Medicaid!

Posted in Advocacy, Medicare
ThinkProgress had an interesting article on the 50th anniversary of Medicaid and Medicare.  President Lyndon B. Johnson signed Medicaid and Medicare into law 50 years ago today. Simply, Medicaid provides health insurance for poor Americans, and Medicare provides insurance for Americans over 65 years old. In 1966 a large portion of seniors were uninsured. Today,… Continue Reading

Medicaid Expansion Would Save Lives and Money

Posted in Advocacy, Medicare, senior care, Tort Reform
As part of the Affordable Care Act’s provisions, expansion of Medicaid benefits has become available to all state governments that accepted the deal in 2014. Many states, however, are declining to participate in the expansion, despite the fact that it would be allocating tax dollars, already given to the federal government by the states, back… Continue Reading

Largest Kickback Scheme

Posted in Advocacy, Medicare, Trial themes
A Miami home health company has agreed to pay $17 million for paying doctors to refer Medicare patients.  Department of Justice officials said that the settlement with Hebrew Homes Health Network Inc. is the largest involving violations of the Anti-Kickback Statute by skilled nursing facilities in the United States. Prosecutors said Hebrew Homes hired numerous… Continue Reading

Largest Medicare Fraud Bust

Posted in Advocacy, Medicare, Trial themes
WGNO reported that the FBI arrested 46 doctors and nurses across the country last month in the largest Medicare fraud bust ever; 243 people were arrested in 17 cities for allegedly billing Medicare for $712 million worth of patient care that was never given or unnecessary.  Four people are charged for mass-marketing a talking glucose monitor and… Continue Reading

Waste, Fraud, and Abuse

Posted in Advocacy, Medicare, Trial themes
The New Yorker had an incredible article written by Dr. Atul Gawande about waste, fraud, and abuse in the health care industry.  This is a fantastic article written by a general surgeon talking about what really drives up medical care – low value and unnecessary care.  Surprisingly, he doesn’t blame “frivolous lawsuits” as many doctors reflexively… Continue Reading

Success of Pioneer Accountable Care Organizations

Posted in Advocacy, Medicare, Trial themes
The American health-care system by and large runs on what experts describe as a “fee-for-service” system. For every service a doctor provides — whether that’s a primary care physician conducting an annual physical or an orthopedic surgeon replacing a knee — the doctor typically gets a lump sum of money. American doctors aren’t paid on… Continue Reading

Recidivist Doctors

Posted in Medicare, Regulatory enforcement, senior care, Tort Reform, Trial themes
Nursing homes with visiting physicians or providers should uncover their troubled histories with Medicaid or Medicare programs in other states or face billing nightmares, and worse, federal scrutiny.  Reuters investigation has revealed that practitioners often go undetected as practitioners in one state after being involved with or kicked out of programs in another state. Reuters… Continue Reading

Inflated Medicare Payments

Posted in Medicare, senior care, Trial themes
The Banghor Daily News reported that the owner of several assisted living facilities will pay $300,000 to resolve a federal lawsuit charging it allowed a subcontractor, RehabCare Group East, Inc., to routinely submit inflated Medicare claims for rehabilitation.  The federal government charged that before Oct. 1, 2011, Rousseau submitted or caused the submission of inflated… Continue Reading

“Race To The Bottom”

Posted in Advocacy, Medicare, Trial themes
The New York Times had an interesting article on the “cutthroat race for Medicare dollars” and how it affects quality of care. Nursing homes are now marketing to sicker people to get Medicare dollars.  At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have… Continue Reading

CMS Requests a Refund

Posted in Advocacy, Medicare, Trial themes
The Telegraph reported that Ronnie Rollins, CEO of Macon-based Community Health Services of Georgia, was “speechless and stunned” when CMS demanded he return more than $100 million in improper payments made to his nursing homes.  The company nursing homes had received the “extra” Medicaid funding in question for more than a decade. This past December, a federal… Continue Reading

HCR ManorCare Whistleblower Lawsuit

Posted in Advocacy, Medicare, Trial themes
ABC News reported that the Justice Department  is stepping into a long-running whistleblower lawsuit against HCR ManorCare, one of the nation’s largest nursing-home chains, accusing it of systematic Medicare overbilling and sometimes putting frail, dying patients through arduous rehab schedules just to increase revenue and profits.  Jeffrey Downey, attorney for the original whistleblower, occupational therapist Christine… Continue Reading

Nursing Home Compare Changes Rating System

Posted in Advocacy, Choosing a nursing home, Medicare, Staffing
The New York Times reported changes to the Nursing Home Compare website on CMS.gov.  The federal government announced that it was changing the way it measures nursing homes, essentially adjusting the curve that it uses to rate homes to make it more difficult for them to earn coveted four- and five-star government ratings.  Under the… Continue Reading

Value Based Payments

Posted in Advocacy, Medicare, Trial themes
The New England Journal of Medicine published an article by Ms. Burwell, the U.S. Secretary of Health and Human Services.  Burwell wrote about the opportunity to shape the way care is delivered and improve the quality of care system wide, while helping to reduce the growth of health care costs.  The Department of Health and Human Services… Continue Reading

Bankruptcy Protects Medicare Reimbursements?

Posted in Advocacy, Medicare, Nursing home cases in the news, Tort Reform, Trial themes
McKnights had an article on a decision that prohibits the government to cut off reimbursements to a nursing home that entered bankruptcy while appealing the termination of its Medicare and Medicaid certification, a federal judge ruled. The controversial decision could lead other nursing homes to enter Chapter 11 to preserve reimbursements. After inspectors cited Bayou… Continue Reading

New Medicare Rules to Deter Abuse

Posted in Medicare, Trial themes
The Wall Street Journal: New Medicare Rules Aim To Reduce Abuse  The Obama administration last week strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government. The move represents a significant shift in how the government tackles waste in Medicare, the insurance program for the… Continue Reading

“Chart Killers”

Posted in Advocacy, Medicare, Trial themes
McKnight’s reported that Skilled Healthcare Group and a Nevada hospice that it operates have been charged with submitting “tens of millions of dollars” in false Medicare and Medicaid claims, the U.S. Department of Justice announced.  Management at Creekside Hospice in Las Vegas used the term “chart killers” to describe documentation showing patients were improving and… Continue Reading

CMS to Update Nursing Home Compare

Posted in Advocacy, Medicare, Regulatory enforcement, Staffing
On Oct. 6, President Obama signed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which aims to improve quality through increased transparency and standardized assessments in several areas surrounding critical care issues across skilled nursing facilities, home health agencies, long-term care hospitals, inpatient rehabilitation facilities, and other post-acute care (PAC) providers.  IMPACT will allow both payments… Continue Reading

Extendicare Settlement with DOJ

Posted in Advocacy, Medicare, Trial themes
Extendicare Health Services Inc. (Extendicare) and its subsidiary Progressive Step Corporation (ProStep) have agreed to pay $38 million to the United States and eight states to resolve accusations that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient that they were effectively worthless and billed Medicare for medically unreasonable and unnecessary… Continue Reading

DOJ Settlement with Johnson & Johnson

Posted in Medicare, Medications
Global health care giant Johnson & Johnson (J&J) and its subsidiaries will pay more than $2.2 billion to resolve criminal and civil liability arising from allegations relating to the prescription drugs Risperdal, Invega and Natrecor, including promotion for uses not approved as safe and effective by the Food and Drug Administration (FDA) and payment of… Continue Reading

False Claims Act

Posted in Medicare, Trial themes
In another story of Medicare fraud, a Seattle doctor admitted filing approximately 900 false claims.  John C. Chen could face up to 45 years in prison because he defrauded the government.  Many of the 900 claims were submitted for patients who were deceased.  Other claims were submitted when he wasn’t even in the country.  See… Continue Reading

Ensign and Medicare Fraud

Posted in Medicare, Trial themes
The Ensign Group Inc. reached a $48 million settlement with the government over allegations that they committed Medicare fraud. The Ensign Group Inc. is a California nursing home management company which runs homes in 10 states. Two former employees filed whistle-blower lawsuits against the home under the False Claims Act, which allocates a portion of… Continue Reading

ObamaCare Slows Health Care Spending

Posted in Medicare
The NY Times reported he growth of federal spending on health care will continue to decline as a proportion of the overall economy in the coming decades, in part because of cost controls mandated by President Obama’s health care law, according to the nonpartisan Congressional Budget Office. The budget office said in its annual 25-year forecast… Continue Reading

ObamaCare in North Carolina

Posted in Medicare
North Carolinians came out in droves for Obamacare enrollment, signing up at a rate that beat nearly every other red state.  More than any other state, North Carolina may represent the huge disconnect between Obamacare’s success in getting people health insurance and its failure to help the Democratic politicians who voted for the law. The… Continue Reading