South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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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

CMS’ Nursing Home Action Plan

Posted in Advocacy, Medicare, Regulatory enforcement, Trial themes
McKnight’s reported on the plan from CMS (FY 2016 to 2017 Nursing Home Action Plan) which laid out five strategies that will “guide” the CMS’ Division of Nursing Homes in improving safety and quality throughout the nursing home industry. The top item is enhancing consumer awareness and assistance in navigating nursing home care, through tools… Continue Reading

CMS To Investigate Therapy Minutes

Posted in Advocacy, Medicare, Trial themes
Medicare reimburses skilled nursing facilities, or SNFs, for “rehabilitation therapy” according to the amount and level of care they provide. The amount of care is measured in minutes per resident per week. The largest payments are awarded to SNFs for residents who receive “very high” or “ultra-high” therapy, respectively equal to at least 500 and 720 minutes per week.… Continue Reading

Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

Posted in Advocacy, Medicare
Bloomberg News reported on a new pilot program from CMS to reduce hospitalizations of nursing home residents.  The Centers for Medicare & Medicaid Services will test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, cut combined Medicare and Medicaid spending and improve the quality of care received by nursing… Continue Reading

Healthcare Fraud Resulting in Death

Posted in Advocacy, Medicare, Trial themes
McKnight’s reported that Rafael Chikvashvili, owner of Baltimore-based Alpha Diagnostics LLC, was convicted of two counts of healthcare fraud resulting in death, wire fraud, false statements and aggravated identity theft. He faces a maximum sentence of life in prison for each of the counts of healthcare fraud resulting in death. Separately, he faces up to 20 years on… Continue Reading

Therapy and Fraud

Posted in Advocacy, Medicare, Trial themes
The Orange County Register had an interesting article regarding the excessive cost and doubtful medical necessity of expensive therapy in nursing homes.  “Nursing homes in California – and notably in Orange County – are outpacing the nation in embracing the most expensive form of therapy for their patients on Medicare, triggering an outcry from some… Continue Reading

Fraudulent Therapy

Posted in Advocacy, Medicare, Tort Reform, Trial themes
As discussed before, the real drivers of healthcare costs are not lawsuits, which studies by Johns Hopkins Medicine found are less than 1% of healthcare costs. The big costs are a result of fraud.  Kindred Healthcare, a large for profit chain of nursing homes, will pay $125 million to settle allegations that it billed Medicare for… Continue Reading

Falsifying Records and Fraud

Posted in Medicare, Regulatory enforcement, Trial themes
CYNCentral and WKTV reported that Mohawk Valley Nursing Home LLC pled guilty to falsifying business records and has agreed to pay $1 million in overpayments to the Medicaid program.  This resolves a case that involved a 45-count indictment that alleged patient abuse and neglect and charges of falsifying records to cover up the incidents at the… Continue Reading

Genesis Settles False Claims Act allegations

Posted in Abuse and Neglect, Advocacy, Medicare, Trial themes
McKnights’ reported that Genesis Healthcare LLC will pay $600,000 to resolve False Claims Act allegations for a skilled nursing facility in Arlington, VA. In addition to the settlement, the nursing home chain will pay for a transition consultant to assist the new operator of the skilled nursing facility for a year. This consultant will help “identify… Continue Reading

PharMerica Settles with South Carolina

Posted in Medicare, Medications, Trial themes
The Post and Courier reported the settlement involving South Carolina and PharMerica to settle allegations of health care fraud.  The federal government contends it illegally promoted the use of Aranesp, a drug used to treat anemia that is manufactured by the pharmaceutical company Amgen. PharMerica has agreed to pay the federal government $2.5 million. PharMerica is a… Continue Reading

“That is wrong on so many levels”

Posted in Advocacy, Medicare, Trial themes
The Times Herald-Record’s recordonline.com reported that Elant Inc.’s civil settlement with NY will not protect them from criminal prosecution for Medicare and Medicaid fraud.  The settlement, however, makes clear that it is civil in nature and does not preclude criminal action or civil suits by individual patients or insurers.  The $600,000 settlement between the state attorney general… Continue Reading

Health Care Fraud

Posted in Advocacy, Medicare, Trial themes
Dr. Robert Hadley Gross, a Texas psychiatrist, has been sentenced to less than six years in federal prison for submitting false claims for services at a nursing home that were never provided.  Gross was also fined $100,000 and must pay $1.8 million in restitution. Gross was found guilty in September of one count of healthcare… Continue Reading

Hospital-Acquired Conditions Reduction Program

Posted in Advocacy, Medicare, Trial themes
Hospital-acquired conditions are a major factor in patient safety. According to the Partnership for Patients, in 2010 adult patients experienced about 4.8 million HACs in 32.8 million hospitalizations. The Agency for Healthcare Research and Quality estimates that the additional cost of HACs ranges from $1,000 for treating a catheter-associated UTI to $17,000 for treating central-line… Continue Reading

Elant Settles Fraud Allegations

Posted in Advocacy, Medicare, Trial themes
LOHud had an article on Elant Inc. settlement with NY.  Elant agreed to pay $600,000 after senior managers admitted directing administrators to delay the release of short-term residents to bilk Medicare and Medicaid out of hundreds of thousands of dollars, according to authorities.  Elant admitted that it postponed the release of short-term residents who were clinically ready… Continue Reading

Sava’s Medicare Fraud

Posted in Advocacy, Medicare, Nursing home cases in the news, Trial themes
McKnight’s reported that the federal government has thrown its weight behind whistleblower complaints against skilled nursing chain SavaSeniorCare LLC.  Authorities joined three lawsuits accusing the massive provider of “routinely” billing for therapy services that were either unnecessary or not medically reasonable.  Prosecutors consolidated the complaints, alleging that SavaSeniorCare “exerted significant pressure” on its skilled nursing facilities… Continue Reading

MedPac to Freeze Medicare Reimbursement Rates

Posted in Medicare, Trial themes
McKnight’s reported that the Medicare Payment Advisory Committee recommended Congress freeze market-basket updates for facilities for fiscal years 2017 and 2018. MedPAC pushed for the payment rate freeze, because the level of Medicare payments to SNFs “remains too high.” The group’s draft also recommends that the SNF prospective payment system be revised, due to differences in… Continue Reading

$25 Million on Psychological Tests!

Posted in Advocacy, Medicare, Trial themes
McKnight’s had an article on two psychologists charged for billing Medicare $25 million for psychological tests on nursing home residents that were either unnecessary or never provided.  Beverly Stubblefield, Ph.D., and John Teal, Ph.D., owned two psychological services companies that contracted to nursing homes in Louisiana, Mississippi, Alabama and Florida. Stubblefield and Teal, along with… Continue Reading