News & Analysis as of

OIG 2014 Work Plan – Skilled Nursing Facilities

Recently, the Department of Health and Human Services Office of the Inspector General (the “OIG”) released its work plan for 2014. The work plan provides stakeholders in the health care industry with a broad overview of the...more

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

Key 2014 Dollar Limits for Medicaid Long-Term Care Coverage Released

The Centers for Medicare & Medicaid Services (CMS) has released the 2014 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep and the limit on how much a home can be worth for...more

Hospitalizations High for Medicare Nursing Home Residents

The Office of the Inspector General (OIG) released a study on November 17, 2013 studying 2011 hospitalization statistics for Medicare nursing home residents. The report finds that one quarter of Medicare nursing home...more

Failure To Maintain Automatic Sprinkler Systems In Nursing Homes Now Leads To Survey Citations And More

As of August 13, 2013, all nursing homes participating in Medicare or Medicaid must have automatic sprinkler systems installed throughout the building. CMS first established the sprinkler requirement in a final rule published...more

Government Benefits For Nursing Home Care

For those nursing home (and assisted living) patients who can qualify financially, Medicaid will provide coverage for as long as needed, unlike the very minimal 100 day maximum under Medicare. As a general rule, the patient...more

CMS Issues Final Rule Regarding Required Agreements Between Long Term Care Facilities and Hospices

Beginning August 26, 2013, skilled nursing facilities participating in Medicare and nursing facilities participating in Medicaid (collectively referred to as “long-term care facilities”) that choose to arrange for the...more

Final Regulations Governing Closure of Long Term Care Facilities

The federal Centers for Medicare and Medicaid Services (CMS) published a final regulation to further implement section 6113 of the federal health reform law, the Patient Protection and Affordable Care Act. The March 19, 2013,...more

OIG Recommends Increased CMS Enforcement of SNF Standards

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

The Latest Zpic Target: Medicare Cost Reports

When Medicare was created in 1966, Medicare paid participating providers (e.g. hospitals and skilled nursing facilities) based on a portion of their costs. Medicare’s portion of costs was determined by multiplying total costs...more

ZPICs and Skilled Nursing Facilities: Medicare’s Wild Wild West

Fraud and abuse in the Medicare system undoubtedly increases healthcare costs for healthcare providers and healthcare beneficiaries. As such, healthcare providers, as a whole, can appreciate the efforts of the Department of...more

Fraud: Skilled Nursing Facilities And Nursing Homes

When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more

Health Care E-Note - December 2012

In This Issue: - Health Care Data Breaches Becoming Major Concern - Hospitals, Doctors Giving Patients Access Through Web Portals - Number of Concierge Doctors Increases 30 Percent in 2012 - Hospitals Battle for...more

Shorts on Long Term Care - May 2012

In this issue: - A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Responding to an Audit? Be Prepared! - Ken’s Quote of the Month An excerpt from...more

A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Shorts on Long Term Care, May 2012

It’s surely a sign of economic times that Poyner Spruill’s long term care lawyers have seen a marked increase in the number of clients calling us for assistance with nonpaying residents. While providers have seen...more

Health Law Alert: Five Things Directors of Nonprofit Health Care Providers Can Learn from Lemington Home

Recently, a federal appeals court in In re Lemington Home for the Aged revived claims brought by unsecured creditors against the directors and officers (D&Os) of the insolvent Lemington Home for the Aged when it reversed a...more

Proactive Medicaid Planning – A Smart Move for Your Family’s Future

If you or a family member is over the age of 65 or ill, call us to schedule your Family Wealth Planning Session today so we can identify what needs to be done to protect your assets for your loved ones and your Medicaid...more

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