South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Category Archives: Medicare

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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

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