Hospitals have been cast in a harsh light by long-term care advocates recently for allegedly over-using “observation stay” status. The practice can ultimately deny some patients subsequent...
Senators see flaws in RAC payment system
By
Elizabeth Newman
Aug 01, 2013
Aspects of the Medicare Recovery Audit Contractor program came under intense scrutiny during a Senate Finance Committee hearing in June. Lawmakers questioned auditor payment incentives and a sluggish appeals...
Florida jury delivers $1.1 billion verdict
By
John O'Connor
Sep 01, 2013
A Florida jury has awarded $1.1 billion in damages to the family of a former nursing facility resident. The amount is believed to be one of the highest ever leveled against a nursing home.
As deaths rise, scrutiny soars
By
Liza Berger
May 01, 2020
As the COVID-19 death toll continued to mount disproportionately among nursing home residents in mid-April, federal regulators issued historic infection and death reporting requirements.
Trump’s CMS pick can expect tough choices: predecessors
By
James M. Berklan
Jan 06, 2017
President-elect Donald Trump’s choice to run the Centers for Medicare & Medicaid Services, Seema Verma, was praised by providers. But she will face tough choices immediately, a previous CMS administrator...
A sense of excitement, complemented by an air of relief, greeted the release of the new RAI manual that gives providers a roadmap for dealing with their new payment system.
Feds ease auditing reviews, anti-fraud efforts to surge
By
John O'Connor
Dec 01, 2013
Providers likely will embrace House legislation that eases billing reviews for operators deemed a low fraud risk.
With Medicaid ‘broken,’ the fight will go to fraud, waste
By
Elizabeth Newman
May 06, 2017
Department of Health and Human Services Secretary Tom Price, M.D., called the Medicaid program “broken” and said it needed a stronger focus on fighting fraud and waste during a House subcommittee...
More than half of fines and settlements from $2.3 billion recouped through healthcare fraud investigations went back into Medicare Trust Funds last year, according to a report issued Friday.
Congress grills top judge on appeals jam backlog
By
Tim Mullaney
Aug 01, 2014
There is no easy fix to the staggering backlog of Medicare appeals, a government official said during a July 10 Congressional hearing.