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.
In this case, the federal investigation found multiple quality of care deficiencies. The provider failed to:
(a) follow appropriate fall protocols;
(b) follow appropriate pressure ulcer and infection control protocols
(c) properly administer medications to avoid medication errors
(d) appropriately provide for activities of daily living including bathing, monitoring, feeding and supervising for some residents
(e) provide appropriate mental health treatment
(f) answer call lights promptly
(g) employ a sufficient number and skill-level of nursing staff to adequately care for the residents
(h) provide a habitable living environment, adequate equipment and needed capital expenditures.
Your best defense is a solid Quality Assurance program. The drumbeat for Quality Assurance and Performance Improvement (QAPI) persists, and for good reason. The QA program should include any regulatory hot buttons, and the quality indicators should collectively represent what your facility considers outstanding care. QA is your central management tool to take a global snapshot of the facility’s performance, communicate with staff what good care looks like, and take quick corrective action when results are out of line.
The best QA programs include a continuous check of your facility’s regulatory compliance status. Surprises from federal and state inspectors are rarely welcome. Arm yourself with good information, and QA is the best mechanism to remain in compliance and avoid OIG penalties. Developing and managing a robust quality assurance program is essential to achieving compliance in nursing homes– because we know it all starts with providing outstanding to service to our residents.
To learn more about how to boost your OIG compliance effort with a strong Quality Assurance Program, see MPA's Quality Assurance Resources.