State high court keeps provider COVID immunity in play but further defines scope
By
Kimberly Marselas
Aug 14, 2023
Connecticut’s highest court has offered a mixed ruling for a nursing home that sought dismissal of a wrongful death suit under a state provision limiting COVID-era liability.
Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays
By
Josh Henreckson
Dec 14, 2023
Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s wrongful reliance on artificial...
Provider sues agency for routine overbilling, unscrupulous practices that led to $5M bill
By
Kimberly Marselas
Mar 21, 2024
A multi-facility skilled nursing operator has filed a lawsuit against the staffing platform Nursa, alleging the app-based agency routinely overbilled for staff that failed to show up for shifts and refused...
PEPPER’s pause doesn’t wipe out prospects for nursing home self-monitoring
By
Kimberly Marselas
Feb 06, 2024
Federal regulators have suspended a key tool used by some nursing homes for internal auditing, but experts cautioned providers not to let the stoppage hinder their compliance efforts.
‘Incomplete’ oversight lets Medicaid managed care denials go largely unchecked: MACPAC
By
Kimberly Marselas
Sep 22, 2023
While much of the outrage around managed care denials has been directed toward Medicare Advantage plans, a federal advisory panel Thursday outlined policies that could force states to better track denials...
CMS ‘naive’ about staffing minimum proposal details, professor claims
By
Jessica R. Towhey
Sep 20, 2023
The proposed federal staffing rule is “shockingly low” and will not measurably improve working and care conditions in nursing homes, consumer advocates claimed during a webinar that was conducted without...
CMS official to providers: Help us capture data to drive Medicare Advantage reforms
By
James M. Berklan
Mar 07, 2024
The increased use of health data and providers’ own voices should be considered among the best tools available for achieving change in a system that increasingly relies on Medicaid Advantage and other...
New state staffing ratios unearth ‘grave’ concerns about vacant jobs, empty beds
By
Kimberly Marselas
Oct 24, 2023
Despite increased state funding that has allowed nursing homes to provide raises for existing staff and increase starting salaries, the number of Pennsylvania providers limiting census due to staffing...
With bankruptcies increasing, lawmakers look to regulate CCRC refund process
By
Kimberly Marselas
Jul 21, 2023
The bankruptcy filing of Illinois’ largest nonprofit life plan community has brought renewed attention to resident refunds, an issue already being targeted for reform by state lawmakers.
Experts fear ‘bigger, stronger stick’ in new Medicare pay rule
By
James M. Berklan
Apr 01, 2024
Nursing home stakeholders are reacting with contempt and concern to key provisions of the newly proposed fiscal 2025 Medicare Part A pay rule.