Breaking Compliance News Blog

Andrew Buffenbarger

Recent Posts

Not-For-Profit Nursing Home Chain Settles False Claims for $750,000

Posted by Andrew Buffenbarger on 6/16/14 4:38 PM

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.

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Topics: Penalties and Enforcement, Quality Assurance

Nursing and Therapy - Essential Compliance Allies

Posted by Andrew Buffenbarger on 7/31/13 11:53 AM

Compelling Incentives

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.

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Topics: Quality Assurance, Billing and Claims Submission, medical necessity

Penalties await those who unknowingly employ or contract with excluded providers

Posted by Andrew Buffenbarger on 5/31/13 11:46 AM

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.

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Topics: Penalties and Enforcement, Excluded Providers

SNFs Fail to Meet Care and Discharge Planning Requirements

Posted by Andrew Buffenbarger on 3/29/13 10:00 AM

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.

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Topics: Penalties and Enforcement, Auditing and Monitoring, Quality Assurance

Is your quality assurance team improving resident care?

Posted by Andrew Buffenbarger on 5/7/12 2:31 PM

Skilled nursing facilities are under intense pressure from regulators, plaintiffs' attorneys, resident families, the public, employees, and most importantly residents to provide the best care. Your quality assurance team is your strongest ally in this effort, but they need to be guided by reliable data. 
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Topics: Quality Assurance

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