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

Fast-Track Nursing Programs: Meeting America’s Growing Need for Nurses?

Across this site, there are 400 plus posts spanning more than a decade. Sprinkled throughout, are posts on staffing and the need for labor, especially nurses. In other words, the U.S. health system, all provider segments, needs nurses and the pandemic exacerbated this need. The need is most critical at the bed side, direct care. … 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

Why Managers Need to Shift Focus from Putting Out Fires to Empowering Their Teams

In my reading stack this weekend (ok, virtual stack), I came across a number of articles on leadership and management. Some were good, some were not, and lots were focused on “old” issues and problems. One in particular, caught my attention – “Management as We Know it Is Broken: How can Leaders Fix It?” What … Read more

Unveiling the Allegations: Lawsuit Claims Advocate Aurora Health’s Monopoly on Health System is Hiking Prices in Wisconsin

Late last week, I ran across a number of news posts regarding a proposed class action lawsuit against the hospital/health system giant Advocate Aurora, alleging that the organization used its market mass to limit competition and in return, impose excessively high prices on commercial health plans and their insureds. The suit was filed in Wisconsin (where … Read more

Rising Tide of Audits: Brace Yourself for Increased Scrutiny on Skilled Nursing Providers in 2024

In 2023, regulators re-instituted audits of facilities for inappropriate diagnoses of schizophrenia (justification for anti-psychotic use), plus a five-claim audit of every nursing home. The purpose of the audit was to address a long-standing concern that inappropriate coding was driving higher Medicare reimbursement under PDPM, despite documentation in patient records, not substantiating the level of care … Read more

Iowa Lawsuit = More Bad News for Assisted Living

In January of 2022, a resident with dementia wandered out of her Assisted Living Memory Care facility in Iowa and ultimately, froze to death. The State of Iowa investigation uncovered that the resident wandered outside of the building at 9:30 p.m. the previous night. Her absence went unnoticed for eight hours plus even though the alarm … Read more

Wednesday Feature: Neglected, Uninspected – Senate Aging Committee Report on SNF Surveys

Happy Hump Day! Yesterday I wrote about the OIG’s (Department of Health and Human Services) report and focus on CMS’ oversight of state survey agencies. The impetus behind this focus no doubt comes from the U.S. Senate Special Committee on Aging’s investigation into nursing home survey activities at the state level. The report is available … Read more

OIG: CMS Should Take Action Against States with Poor SNF Survey Performance

Last week, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), issued a report regarding the performance of contracted state agencies with respect to nursing home (SNF) compliance surveys. CMS contracts with state agencies, typically state departments of health or divisions thereto, to perform compliance/regulatory activities (surveys) in nursing homes. The report … Read more

Conference Board Report/C-Suite Outook for 2024: Concerns Ahead

The Conference Board, a renowned non-profit research organization, has recently released a comprehensive report that sheds light on the business outlook and concerns of CEOs for the year 2024. This study offers valuable insights into the minds of top executives, highlighting their attention towards the economy and organizational talent. In this post, I’ll delve into … Read more