South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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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

Medicaid Fraud in Tennessee?

Posted in Advocacy, Medicare, Trial themes
The Tennessean reported that Kathleen Graves, the owner of  Mabry Healthcare & Rehab Center, claimed more than $2 million in Medicaid expenses that were instead spent for personal use, including purchases at discount stores, restaurants, furniture stores, nail salons, personal travel and, in one instance, to help pay for the wedding of the owner’s daughter!  The Tennessee… Continue Reading

DOJ Settlement with NAHC, Inc.

Posted in Advocacy, Medicare, Trial themes
California Healthline reported the $30 million DOJ settlement involving North American Health Care Inc. and two of its executives.  They will pay back $30 million after they billed government health care programs for unnecessary treatments. The company will pay $28.5 million, the bulk of the settlement, while John Sorenson, chairman of the board, will pay $1… Continue Reading

Medically Unnecessary Services

Posted in Medicare, Trial themes
The DOJ sent a press release disclosing the settlement between AJIT Healthcare, Inc. (doing business as Westlake Convalescent Hospital nursing home), Dr. Jasvant Modi, and Dr. Meera Modi who agree to pay $3,563,140 to resolve civil allegations that they participated in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary… Continue Reading

Fraudulent Medicare Billing

Posted in Medicare, Trial themes
The Fresno Bee reported that two psychologists from Louisiana and Mississippi admitted to a $25 million Medicare scam by billing for unnecessary or nonexistent tests on nursing home patients across the Southeast.  As part of their guilty pleas, Beverly Stubblefield and John Teal admitted they’re responsible for more than $5.6 million in fraudulent claims submitted… Continue Reading

Payroll-based Journal

Posted in Advocacy, Medicare, Staffing
The Affordable Care Act’s mandatory nursing home staffing requirement went into effect requiring long term care facilities to provide “payroll-based journal” data to the federal government on a quarterly basis, starting in November, 2016.  The first required reporting period started July 1, 2016, with the first required submission deadline on November 14 (45 days after… Continue Reading

Nursing Home Compare

Posted in Advocacy, Medicare, Staffing, Trial themes
CMS launched Nursing Home Compare in 1998, adding the Five Star Nursing Home Quality Rating System in 2008. Through the Five-Star program, CMS summarizes available data for nursing homes in a consumer-friendly format while providing comparisons against state and national data for reference. On August 10, 2016, CMS added five new quality measures to the… Continue Reading

Genesis $52.7 Million Settlement with DOJ

Posted in Medicare, Regulatory enforcement, Staffing, Trial themes
McKnight’s reported that national for profit nursing home chain Genesis Healthcare has agreed to settle with the DOJ for $52.7 million under an “agreement in principle” to settle four separate U.S. Department of Justice investigations.  The provider currently operates nursing homes in 34 states and employs nearly 90,000 workers nationwide. The settlement will resolve allegations over… Continue Reading

New Medicare Rule

Posted in Advocacy, Medicare
The New York Times had a great article explaining the new Medicare rule enacted this past Saturday.  Medicare does not pay for nursing home care unless the resident was admitted to the hospital as an inpatient for 3 days immediately prior to admission into the nursing home facility.  Hospitals have been keeping patients in limbo… Continue Reading

Quality Measures added to NH Compare

Posted in Advocacy, Medicare
Leading Age website had an article from LeadingAge’s MDS expert consultant, Judy Wilhide-Brant, RN, providing guidance on the 3 new MDS-based quality measures to be added to CMS Nursing Home Compare beginning April, 2016. These measures are calculated using two ADLs in G0110 that have not been used before.  She offers a guide to coding and… Continue Reading