The US Attorney and OIG reported on June 14th that a not-for-profit chain of nursing homes agreed to pay $750,000 to resolve False Claims Act violations related to the provision of worthless services. This False Claims Act enforcement represents a growing trend where the government can require SNFs to repay Medicare and/or Medicaid funds if the government believes the care is substandard and does not meet the conditions of participation.
We all know that the OIG is increasingly concerned about over-utilization of therapy, and accuracy of care plans. Care plans that are insufficiently documented or overly aggressive, or that are not tailored to the specific resident can lead to false claims - including the over-utilization of therapy services. In order to maximize compliance and avoid penalties related to therapy utilization and care plan accuracy, nursing and therapy must work together.
The OIG recently released a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. The purpose of the bulletin is to remind providers of the prohibition on payment from Federal health care programs when services are provided by 1) an excluded person or 2) at the medical direction or on the prescription of an excluded person. Essentially, providers cannot use Federal health care program dollars to pay for the work of excluded individuals or companies.
The OIG recently released a review of SNF care and discharge plans. The OIG found that 37% of SNFs did not meet the care planning requirements or did not provide services in accordance with care plans. They go on to say that for 31% of stays, SNFs did not meet discharge planning requirements. The OIG calls for stricter oversight of SNF care and discharge plans as Medicare paid approximately $5.1 billion for stays in which SNFs did not meet the requirements.
Topics: Quality Assurance