News & Analysis as of

Audits Long Term Care Facilities

Dentons

Ep. 61 – Three Compliance Lessons from a False Claims Act Verdict

Dentons on

In a recent False Claims Act case, a long-term care pharmacy and consulting services provider was found liable for submitting false claims to the government, resulting in a jury verdict of over $135 million in damages. The...more

Husch Blackwell LLP

Hospice Insights Podcast - Controlling the Narrative: A New Tactic for Auditors and ALJs

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Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice Podcast - Episode 6: Navigating the Audit Maze: Insights From Northeast Georgia Health System

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by Kathy Barton and Natalie McNeal of Northeast Georgia Health System. Kathy and Natalie share insights on navigating the complexities of hospice...more

Husch Blackwell LLP

Hospice Insights Podcast - What's the Latest on UPICs? Highlights From Recent Audit Activity, Part II

Husch Blackwell LLP on

UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki continue the discussion on these trends which include extrapolation, Medicaid nursing...more

King & Spalding

Sixth Circuit Upholds Validity of Medicare Audit Despite Lack of Notice, Citing Lack of Substantial Prejudice

King & Spalding on

On June 24, 2020, the U.S. Court of Appeals for the Sixth Circuit issued an opinion addressing whether an overpayment assessment should be invalidated when the Medicare contractor fails to provide notice of a post-payment...more

Bricker Graydon LLP

CMS directive orders state agencies to increase weekend surveys of skilled nursing facilities

Bricker Graydon LLP on

Staffing in long-term care facilities significantly affects the care delivered to residents. Since July 2016, nursing homes have been reporting staffing data electronically through the payroll-based journals (PBJ) system....more

Ruder Ware

Inspector General Audit Could Impact Skilled Nursing Facilities

Ruder Ware on

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and...more

Bond Schoeneck & King PLLC

Health Law Wire: OMIG Standards for PRI Audits Held Arbitrary and Capricious (7/15)

The Office of the Medicaid Inspector General (OMIG) was recently given a set-back in its on-going audits of nursing home case mix submissions. These audits focus on “Patient Review Instruments” (PRIs) which form the basis of...more

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