Tag: Post Acute
Ohio had their hands full in a federal case involving a former home healthcare nurse who committed heinous crimes and Medicaid fraud involving a severely physically disabled 14-year-old minor (cerebral palsy) in her care. As a result of her neglect and fraud, she also received a lifetime ban from working in any governmental entity in the healthcare field.
On June 30, the Center for Clinical Standards and Quality/Survey & Certification Group issued a memorandum outlining revisions to the State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag revisions, and several other related issues specific to the Requirements of Participation of nursing centers. The new CMS mandates include the minimum health and safety standards that skilled nursing facilities must meet to participate in Medicare and Medicaid.
Like most compliance officers, I receive compliance updates in my inbox every day from various vendors, compliance organizations, and of course the Office of Inspector General and Department of Justice. I always make sure to read all of the recent government settlements but maybe because of my background and love for the post-acute sector, I continue to notice how frequently the OIG and DOJ focus on the post-acute sector, and often more specifically on skilled nursing facilities.
The OIG has heard and seen it all, right? It is hard to imagine the daily insanity of discovering and investigating fraudulent behavior within the healthcare industry. One thing is for sure; they are not messing around.
Did you read the new Skilled Nursing Facility Requirements of Participation (ROP) section 483.12 carefully? In a document of nearly 200 pages and three columns of small print, sometimes it is easy to miss an important change. I read the new ROP multiple times and until just a few weeks ago I missed an important new requirement in the Freedom from abuse, neglect and exploitation section. Hopefully, you aren’t like me and you saw this already but just in case I thought I would highlight the change for you and give you some great news about meeting this new requirement.
If you are feeling overwhelmed, I completely understand, but the good news is that the implementation of these Requirements is in three phases. The first of course went into effect November 28, 2016, but Phase II and III you have a little more time. Phase II goes into effect on November 28, 2017 but Phase III not until November 28, 2019.
As we all know the new Requirements of Participation (ROP) for Skilled Nursing Facilities (SNF) were published in the Federal Register on October 4, 2016 with the Phase 1 requirements going into effect on November 28, 2016. The Requirements of Participation have not been significantly altered in nearly 25 years. So as you can imagine, there are some significant changes that come with these new Requirements.
There are several reasons why the long-term care industry (LTC) is, has and will continue to be a key focus of health care enforcement and regulatory affairs. You are probably thinking that the primary reason is because it deals with the elderly and vulnerable, and that is one part. But, when you take a look at the myriad of fraud and abuse cases that have taken place and continue to be investigated and prosecuted, coupled with how the bad actors slip under the radar with tact, you quickly see that the LTC business is very lucrative and full of opportunities to cheat the system.
Effective Sept 6, 2016, fines more than doubled. Skilled Nursing Facilities Congress raised the maximum penalty for noncompliance resulting in an immediate jeopardy outcome over 100%. The sanctions went from a per day minimum penalty of $3,050 to $6,291 and the maximum from $10,000 to $20,628. That is more than a 100% increase in this penalty. In addition, the minimum per instance sanctions went from $1,000 to $2,063 and the maximum per instance went from $10,000 to $20,628. Did you know that there are fines if an individual notifies the skilled nursing facility of an impending survey prior to its occurrence? Or that a nursing facility could be penalized over $217,000 for employee retaliation if an employee calls the state?
A federal judge sentenced the CEO of an Illinois Home Health company to six (6) years in prison following a jury verdict convicting on grounds of fraudulently billing Medicare for millions of dollars of unnecessary services. The Assistant U.S. Attorney that prosecuted the case commented that "Home-health fraud has become a significant problem nationally and particularly in the Chicago area."