Recent HIPAA Right of Access Settlements Highlight Ongoing Enforcement Efforts

SNFs this one is for you! Yesterday’s post on billing fraud was too. It almost feels as if this second week of April has a compliance theme while last week, the focus was on CMS Proposed Rules. Assuredly, Wednesday will bring some different news as March CPI data drops. This news came last week via … Read more

Medicare, DOJ, Fraud and the Eclipse?

Happy Eclipse Monday! The post title is meant as a bit of fun but there is a bit of relevancy as well. Billing fraud occurs via a process of hiding what actually has transpired (or should have) with the care of a patient. The most typical fraud is overbilling or charging the government for care … Read more

Wednesday Feature: Hospice Proposed Rule for 2025

Happy Hump Day! As I wrote in a post on Monday regarding CMS’ Proposed Rule for SNFs, ’tis the season. This time of year, is when CMS drops proposed changes to reimbursement and other programmatic elements for all provider types, save Home Health which comes a little later (Home Health rate year is calendar year … Read more

CMS Releases 2025 PPS Proposed Rule for SNFs

It’s that time of year again where CMS begins to drop various rule proposals for updates to provider groups under PPS. From Hospitals, to SNFs, to Home Health and Hospice, each industry segment will see a proposed series of rate and programmatic (rule) updates from CMS. This is normal and it occurs at about the … Read more

Skilled Nursing Operator Takes Legal Action Against Staffing Platform for Alleged Overbilling

A little over a week ago, an SNF operator dropped a lawsuit in U.S. District Court in the District of Utah against a staffing platform that works somewhat, like a staffing agency. The platform Nursa acts as a software clearinghouse connecting nursing staff (RNs. LPNs, CNAs, etc.) to facilities with open shifts – “Nursa exists … Read more

Penn and Teller and the Disappearing SNF

When I got married to my wife and business partner (the partner came after), part of our honeymoon was spent in Las Vegas. While there, we caught Penn and Teller’s Vegas show and it was AWESOME! I love magic and in particular, the kind that is up close and personal. The trade term now seems … Read more

Record-breaking $2.7 Billion Paid by Healthcare Providers in False Claims Act Cases

A couple of weeks ago, on February 22nd. the Department of Justice issued its annual statement regarding False Claims Act activity in FY 2023 (federal fiscal years run 10/1 to 9/30). “Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023. The government and whistleblowers were … Read more

Friday Feature: Legal Battle Unfolds Over Nursing Home Negligence Amid Pandemic Era

TGIF! Within a busy econ news week, a little litigation matter slipped into my news stream. These cases are fascinating as we continue to see the pandemic litigation trickle forward and the novelty of claims arising from the pandemic period/Public Health Emergency period beginning to define the litigation playing field. Readers/followers know by now that … Read more

Unlocking the Potential: Overcoming Challenges for LTPAC Providers in ACO Participation

Yesterday, the American Health Care Association and the National Center for Assisted Living plus the National Assocation of ACOs released a white paper that includes a set of recommendations for CMS, designed to increase the participation of long term and post-acute care (LTPAC) providers in accountable care organizations (ACOs).  The white paper is available here: AHCA … Read more

Wednesday Feature: Navigating the Evolving Landscape – Enhancing Ethics and Compliance Programs for Risk Mitigation

Happy Hump Day! Long title for what is going to be, a rather brief post.  As followers and regular readers know, my firm (I am the co-founder and part owner) H2 Healthcare, LLC has a practice area uniquely concentrated on clinical compliance and complex litigation support.  The practice area is headed by Diane Hislop, RN (yes, … Read more