South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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“The scheme was characterized by unbridled greed”

Posted in Medicare, Trial themes
The Indianapolis Business Journal had an article about the fraud and greed that led to the indictment of nursing home owner and operator James Burkhart.   In an explosive federal indictment unsealed in October, kickback money was used to buy gold bullion, casino chips, and vacation homes in a massive fraud scheme.  The fraud and kickbacks… Continue Reading

Dumping for Profit

Posted in Abuse and Neglect, Advocacy, Medicare, Trial themes
Herald Mail Media reported on the accusation of resident dumping by the owner/operator of five Maryland nursing homes.  The suit alleges that during a 17-month period between Jan. 1, 2015, and May 31,  Neiswanger Management Services LLC issued involuntary discharge notices to at least 1,061 residents at the five facilities it operates. NMS and a… Continue Reading

Repeal and Delay…..Forever

Posted in Advocacy, Medicare
Jonathan Chait for New York Magazine had a great article on the Republican strategy to repeal ObamaCare and replace it with nothing.  He argues they have no plan and no political courage to pass anything.  Below are excerpts: The Republican Party has used health care to its advantage for the last seven years by following… Continue Reading

ObamaCare Enrollments

Posted in Advocacy, Medicare
The L.A. Times reported that millions of Americans are scrambling to get insurance coverage through ObamaCare before the Republicans attempt to replace the successful health care law.  As of Dec. 24, more than 11.5 million people had enrolled in a health plan through one of the insurance marketplaces created by the law according to federal… Continue Reading

Tom Price’s Self-Dealing

Posted in Advocacy, Medicare
Buzzfeed reported on the sordid politics of Georgia Republican Tom Price who has been chosen to lead the DHHS.  Price has long criticized federal spending as excessive unless it directly benefited his campaign donors.  Price has been a go-to congressman for medical special interests sparring with safety regulators or facing budget cuts. In other cases, he has… Continue Reading

Replace before Repeal

Posted in Advocacy, Medicare
An overwhelming majority of people disapprove of Republican lawmakers’ plan to repeal the Affordable Care Act without having a ready replacement for the health care law.  NPR reported on a poll released by the Kaiser Family Foundation finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only… Continue Reading

Obamacare: How to Repeal and Replace?

Posted in Advocacy, Medicare
There has been a lot of discussion and misinformation about the success and failures of the Affordable Care Act.  Several articles have appeared recently discussing the difficulty in repealing the Act and how to replace it with something that will be affordable and provide better quality of care. New York Magazine had an article explaining… Continue Reading

Whistle-Blowers and Fraud

Posted in Advocacy, Medicare, Trial themes
The Econo Times had an article from Christine Zack.  Ms. Zack is an in-house attorney for the national for-profit chains Fundamental and Mariner.  She is also the Executive Vice President, Chief Strategy Officer at Mariner Health Central, Inc. and Senior Vice President, Chief Risk Officer of Fundamental Administrative Services, LLC. Zack was recently a panelist in… Continue Reading

Medicare Payments are still too high

Posted in Advocacy, Medicare
McKnight’s reported that The Medicare Payment Advisory Committee (MedPAC) recommended that market basket updates for skilled nursing facilities be eliminated for fiscal years 2018 and 2019 — restating for a second year that current payment levels for providers are “too high.” The group’s draft recommendations include to freeze the market basket update for both FY 2018 and… Continue Reading

Trump’s Bizarre Choice to lead HHS

Posted in Advocacy, Medicare, Regulatory enforcement, Tort Reform
There are plenty of reasons to be worried about Tom Price, President-elect Donald Trump’s choice for secretary of Health and Human Services.  Price is an orthopedic surgeon and U.S. congressman from Georgia with no relevant experience. Price has often and repeatedly voted to cut Medicaid and Medicare,  and is an ardent opponent of female reproductive… Continue Reading

OIG To Analyze Therapy Billing

Posted in Medicare, Trial themes
HHS OIG Work Plan 2017 states that health officials will analyze Medicare reimbursements and therapy billing in nursing homes during fiscal year 2017.  “Previous OIG work found that SNFs are billing for higher levels of therapy than were provided or were reasonable or necessary,” the report reads. “We will review the documentation at selected SNFs… Continue Reading

Corporate Whistleblower Center

Posted in Advocacy, Medicare, Regulatory enforcement
The Corporate Whistleblower Center is appealing to health care providers to call them anytime at 866-714-6466 if they possess proof of Medicare over-billing for unnecessary medical procedures involving their employer. According to the Justice Department on October 24th, 2016, “Medicare reimburses skilled nursing facilities at a daily rate that reflects the skilled therapy and nursing needs of their qualifying… Continue Reading

Whistle-blowers Awarded $29 Million

Posted in Medicare, Nursing home cases in the news, Trial themes
The FCPA blog which focuses on the Foreign Corrupt Practices Act had a great article on two whistle-blowers–Tammie Taylor and Glenda Martin formerly worked for Life Care Centers of America Inc.  Life Care is based in Cleveland, Tennessee and owns and operates more than 220 skilled nursing facilities across the country including South Carolina. These heroic… Continue Reading

Increase in Ventilator Use

Posted in Advocacy, Dementia Care, Medicare
Fox News had an interesting article on the increase of ventilator use among dementia residents in nursing homes. “The number of nursing home residents with advanced dementia who get hooked up to breathing machines has roughly doubled in recent years even though this doesn’t appear to help them live longer, a U.S. study suggests.” Alzheimer’s… Continue Reading

Medicare Advantage v. Fee for Service Medicare

Posted in Advocacy, Medicare
The Rand Corporation studied the differences in care provided to residents with Medicare Advantage (MA) and traditional fee-for-service (FFS) Medicare.  The study was published in the Journal of the American Medical Directors Association, v. 17, no. 10, 1 Oct. 2016, p. 960.e9-960.e14. “Overall, we found few differences in NH quality scores between MA and FFS Medicare… Continue Reading

“Materially substandard nursing services”

Posted in Abuse and Neglect, Advocacy, Medicare, Trial themes
The following is a release from the U.S. Attorney’s Office: Daybreak Partners, LLC, a holding company for a number of subsidiaries that operate and manage skilled nursing facilities throughout Texas, has agreed to pay $5,300,000.00 to resolve allegations that they billed Medicare and Medicaid for materially substandard nursing services.  The skilled nursing facilities are operated… Continue Reading

Occupancy Levels Decline

Posted in Advocacy, Medicare, Trial themes
The National Real Estate Investor had an interesting article about declining occupancy levels at nursing homes.  Occupancy levels at nursing homes around the country have hit 82.2 percent, a five-year low for the skilled nursing profession, according the National Investment Center for Seniors Housing & Care (NIC). A notable drop in skilled mix, the industry… Continue Reading

Life Care Center’s Settlement with DOJ

Posted in Medicare, Trial themes
Forbes had an article on the recent settlement between the DOJ and Defendants Life Care Centers of America, one of the nation’s largest nursing home chains, and its billionaire owner Forrest Preston.   Life Care and Preston have agreed to pay $145 million to settle a government lawsuit alleging that the firm had knowingly overbilled… Continue Reading

Reliant Senior Care Holdings Settlement

Posted in Advocacy, Medicare, Trial themes
CBS Pittsburgh reported the $2 million settlement with Reliant Senior Care Holdings related to claims of failing to provide basic services to their customers.  The company operated 22 skilled nursing facilities throughout Pennsylvania from 2012 to the present. An investigation revealed Reliant left its facilities understaffed, making workers unable to help those living there with such basic needs… Continue Reading

“Unbridled Greed.”

Posted in Advocacy, Medicare, Trial themes
The Washington Times Herald reported the indictment against James Burkhart, CEO of American Senior Communities, for   federal charges in a kickback scheme worth millions of dollars.  American Senior Communities operates dozens of Indiana nursing homes including two in Washington.  The defendants used American Senior Communities’ network of about 70 nursing homes and thousands of patients to their… Continue Reading

Expenditure Transparency

Posted in Advocacy, Medicare, Trial themes
McKnight’s had a great article on the recent GAO Report on Access to Expenditures.  The Report concludes that information on how and why nursing homes spend money should be accessible to public stakeholders.  The investigation found that information on expenditures is not readily accessible to the public or verified for accuracy and completeness. “GAO investigators created… Continue Reading

Inflating the Cost of Medicare

Posted in Medicare, Trial themes
The Boston Herald reported the $2.2 million settlement to resolve allegations concerning inflated Medicare claims. Prosecutors say that Health Concepts and its COO, John Gage, failed to take sufficient steps to prevent Therapy Resources Management from fraudulently inflating the reported amounts of therapy provided to certain Medicare patients in Health Concepts facilities. Prosecutors say the facilities… Continue Reading

New Rules from CMS

Posted in Advocacy, Medicare, Staffing
Forbes wrote an article on new rules established by CMS for nursing homes that voluntarily accept federal and state taxpayer funding,  The last time CMS revised the regulations were 25 years ago.  A lot has changed since then. “The new regulations—all 700 pages worth—govern everything from staffing and dispute resolution to enhancing the role of… Continue Reading

Medicare Fraud and SavaSeniorCare

Posted in Medicare, Trial themes
McKnight’s reported on the lawsuit that accuses SavaSeniorCare, one of the nation’s largest nursing facility operators, of overbilling Medicare for unnecessary therapy services.  Sava filed a motion to dismiss but a federal court has ruled the lawsuit can proceed.  The lawsuit, which consolidated three separate complaints against SavaSeniorCare LLC, alleges that the company pushed employees to provide… Continue Reading