Tag: audits

Study finds that SNFs who score well on quality measures does not prevent deaths or readmissions

A skilled nursing facility that scores well on quality measures is not necessarily reducing residents’ risk of death or readmission within 30 days of arriving from a hospital, according to a study published in the American Medical Association journal JAMA. The investigation determined that with SNFs that score well on facility inspections ratings, Medicare beneficiaries do […]

Judge blocks new RAC contracts

The controversy around Medicare’s Recovery Audit Contractor program continues; a judge has ruled that the government cannot award new RAC contracts until disputed payment terms are resolved. Long-term care providers have been watching the RAC contract process because current audits have been largely put on hold. CMS has indicated that the awarding of new contracts is […]

LTC providers bear burden of poor oversight of Medicare auditors

Long-term care and other providers could be facing unfair burdens due to ineffective government oversight of Medicare auditors, according to a new report from the Government Accountability Office. The Centers for Medicare & Medicaid Services does keep a database to track Recovery Audit Contractor activity and prevent them from reviewing the same claim multiple times, […]

OIG reverses course on referral services discounts

Providers cannot use an online service that involves money for referrals within its network, federal regulators now say, reversing course on an advisory opinion that was first issued three years ago. The statement came from the Department of Health and Human Services Office of Inspector General. The notice of termination on OIG Advisory Opinion No. 11-18 was […]

Medicaid Fraud Control Units recover over $10 million in 2013

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in FY 2013, according to an annual report issued Friday. Practically every state operates a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all of these units. The investigations included: Allegations of […]

Ask the Expert: Observation status

Q: A nursing home sends a SNF patient to the emergency room, after a fall.  A small scalp laceration is sutured, and a CT scan of the head shows no abnormality.  The patient is stable, and a decision is made by the treating physician, that the patient can return to the nursing home.  The patient’s primary […]

New Medicare notices gives seniors a tool to help fight against fraud

Medicare beneficiaries will start receiving a redesigned statement of their claims for services and benefits that will help them spot potential fraud, waste, and abuse, according to a recent press release by the Centers for Medicare & Medicaid Services. The redesigned notice will make it easier for people with Medicare to understand their benefits, file […]

GAO issues report on state of ZPICs

A new report from the U.S. Government Accountability Office (GAO) finds that Zone Program Integrity Contractors (ZPICs) have stopped more than $250 million in savings to Medicare in calendar year 2012 from actions such as stopping payment on suspect claims. According to the report, ZPICs reported taking other actions to protect Medicare funds, including having […]

CMS states citations at F-tag 454 no longer apply

In an October 25 memo to state survey agency directors, the Centers for Medicare & Medicaid Services (CMS) announced that citations at F-tag 454 no longer apply. The memo states that the regulations at §483.70 are covered by the Life Safety Code (LSC) requirements and all citations under these regulations should be made under the […]

OIG releases report on Medicare A and B redeterminations

Earlier this month, the Office of the Inspector General (OIG) released a report titled, “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness”. According to the OIG, the Medicare appeals process serves as an important protection for beneficiaries and providers. Their study represents the first examination of redetermination, i.e., the first […]