Articles and Blogs

President Obama introduced his fiscal year (“FY”) 2015 budget yesterday, and there are many proposed cuts to post-acute care providers.  Some of the highlights include a number of bundled payment initiatives, a $100 co-pay for home health patients not discharged from a hospital and re-admission penalties for skilled nursing facilities (“SNFs”) with high hospital... READ MORE

The Centers for Medicare and Medicaid Services (“CMS”) announced today the contract suppliers for Round 2 and the national mail-order program of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) Competitive Bidding Program. As of April 9, 2013, there are 799 suppliers that have been awarded contracts in this round, and these contracts will affect... READ MORE

On September 14, 2012, CMS published a Survey and Certification letter addressing “Hand in Hand: A Training Series for Nursing Homes.” This training is in response to Section 6121 of the Affordable Care Act, which requires that CMS ensure that nurse aides receive regular training on caring for residents with dementia and prevention of... READ MORE

The Federal Government has reinforced its expanded theory of false claim liability for quality matters by settling allegations against a hospital that a physician’s lack of qualifications to perform certain surgical procedures should be considered a false claim, regardless of the patient’s outcome. As part of the settlement, the hospital defendant paid the Government... READ MORE

On November 30, 2011, Daniel R. Levinson, Inspector General, appeared before the Special Committee on Aging, and testified regarding the Office of Inspector General’s (OIG) findings pertaining to the use of atypical antipsychotic drugs by nursing home residents. The OIG hired psychiatrists who are experts in treating elderly patients to review a sample of... READ MORE

A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25.  The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct.... READ MORE

On October 31, 2011, the final rule (Rule) to update the Home Health Prospective Payment System (HH PPS) for Calendar Year 2012 was published in the Federal Register.  As a result of the Centers for Medicare & Medicaid Services (CMS) implementing the Rule, home health agencies (HHAs) will experience a decrease in payments of... READ MORE

Pursuant to Section 6111 of the Affordable Care Act enacted on March 23, 2010, and the final rule published on March 18, 2011 in the Federal Register, a nursing facility must be offered the opportunity to request an Independent Informal Dispute Resolution (IIDR) if the Centers for Medicare & Medicaid Services (CMS) imposes a... READ MORE

On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million.  According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who... READ MORE

On October 5, 2011, the Office of Inspector General (OIG) published its proposed Work Plan for Fiscal Year 2012. As in the past, the Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The 2012 Work Plan contains several new areas of focus by... READ MORE