AI-shortened nursing home stays drive potential class action suit against insurer
By
Kimberly Marselas
Nov 16, 2023
The nation’s largest insurer is illegally using programs driven by artificial intelligence to override the decisions of medical professionals and wrongfully force seniors from nursing homes, a potential...
CMS provides first look at shorter, Risk-Based Survey process
By
Kimberly Marselas
Apr 04, 2024
The Centers for Medicare & Medicaid Services on Wednesday revealed initial information about a potential “Risk-Based Survey” option that could be available to some of the nation’s best performing...
Court orders attorney to pay nursing home legal fees in ‘frivolous’ False Claims case
By
Kimberly Marselas
Feb 07, 2024
An attorney who brought a False Claims case against a Mississippi long-term care provider using publicly available — and later disproven — information must pay the facility’s legal fees, a court...
A key Medicaid advisory body appears ready to recommend new appeal opportunities for millions of Managed Medicaid beneficiaries and to add more oversight to better ensure plans cover medically necessary...
Layering of fines amid state, federal staffing rule conflicts tops providers’ worry list
By
Kimberly Marselas
May 02, 2024
Providers in states that have recently increased their own nursing home staffing requirements may soon find themselves playing a complicated penalties and numbers game — and buried in additional paperwork.
Nursing home averts picket after promising $80K in bonuses
By
Kimberly Marselas
Oct 26, 2023
A group of nursing home workers who threatened to picket their employer this week put down the placards after being promised more than $80,000 in bonuses their union says they are owed.
New federal initiatives increase criminal enforcement concerns for nursing homes
By
Kimberly Marselas
Jan 03, 2024
Already facing heightened regulatory pressure, skilled nursing operators could find themselves the subject of more criminal investigations in 2024 with the Biden administration ramping up efforts to investigate...
Nursing home fights for right to end temporary bonuses, avoid $369K payout
By
Kimberly Marselas
Apr 15, 2024
Can a nursing home end an emergency bonus program for unionized workers without negotiating after a contract has expired?
Medicare Advantage plan settles upcoding allegations for $22.5M
By
Kimberly Marselas
Aug 02, 2023
A Medicare Advantage plan will pay $22.5 million to settle allegations that it systematically reviewed patient charts to tack on additional charges before submitting claims to Medicare, federal law enforcement...
Senator renews call for surveyor funding after staffing rule release
By
Kimberly Marselas
Sep 15, 2023
An influential senator is renewing his calls for increased funding for state survey agencies, following the release earlier this month of a federal staffing minimum that would require extensive on-site...