Tag: audits

Tip: Audits and the False Claims Act’s far reach

If the results of an internal audit determine that Medicare was billed inappropriately, the provider is in potential violation of the False Claims Act, which describes a violator as any entity or person that causes the federal government to make payments for goods or services that are a) not provided, b) provided contrary to federal […]

OIG updates LEIE database file: Why should LTC providers care?

An updated List of Excluded Individuals and Entities (LEIE) Database file has been released by the Department of Health and Human Services, Office of Inspector General (OIG), including all OIG exclusions and reinstatements made through July 2017. Why do LTC providers need to know about this? The OIG recommends long-term care providers check this list […]

Experts share concerns regarding emergency preparedness requirements

Several emergency preparedness experts shared their concerns regarding providers’ ability to meet compliance with emergency preparedness (EP) requirements during a May 17 interview with Modern Healthcare’s Steven Ross Johnson. The Centers for Medicare & Medicaid Services (CMS) published the final rule on September 16, 2016, mandating that facilities—including skilled nursing facilities, nursing homes, home health […]

OSHA: Deadline to submit Form 300A extended

Following a final rule published in May 2016 regarding the electronic submission of Form A, the Occupational Safety and Health Administration (OSHA) announced they will be extending the submission deadline from July 1, 2017 to a new deadline, which has not yet been shared. Employers that have 250 or more employees are required to submit […]

Legal repercussions for posting about residents on social media are not limited to just a few

Recent media coverage tells a sad story about inappropriate usage of social media in long-term care settings¾one that details not only severe legal repercussions for facilities, but also major violations of resident privacy and cases of mental abuse. While privacy and abuse are not black and white matters, the issue of photographs, videos, and identifying […]

Pre-pay audits target J5 providers in IA, KS, MO, NE and national

J5 Jurisdiction providers are being targeted for prepayment, service specific, complex medical reviews of Inpatient SNF services conducted by Wisconsin Physician Services Government Health Administrators (WPS GHA), a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS). J5 Jurisdiction includes skilled nursing facilities (SNF) that submit claims from Iowa, Kansas, Missouri, […]

OIG updates LEIE Database: Why should LTC providers be aware of this?

An updated List of Excluded Individuals and Entities (LEIE) Database file has been released by the Department of Health and Human Services, Office of Inspector General (OIG), including all OIG exclusions and reinstatements made through February 2017. Why do LTC providers need to know about this? The OIG recommends long-term care providers check this list […]

Obstructing audits could now result in providers’ exclusion from Medicare and Medicaid

A new rule published on the federal register today by the Department of Health and Human Services (HHS) states that all individuals and entities convicted of interfering with or obstructing audits and investigations may face exclusion from Medicare and Medicaid. The HHS Office of Inspector General will be limited to a 10-year timeframe to pursue […]

Core Administrative Competency: SNF by Reginald Hislop III

As I have written before and readers know, I field as many questions and provide as many resources as I can “free” of charge.  My e-mail is publicly available for contact on this site and on my LinkedIn page.  The title of this post thus, is a reference to the many questions I’ve received as of […]

Senate Finance Committee holds hearing on Medicare appeals system

On April 28, 2015, The Senate Finance Committee held a hearing about the Medicare appeal problems, focusing on the immense backlog at the ALJ level.  The committee members considered ways to fix problems at the center of the appeals backlog. However, the current proposals don’t work; they would further restrict access to meaningful reviews. Current […]