A recent Office of the Inspector General (OIG) Report reviews progress made by the Office for Civil Rights (OCR) toward enforcement of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule following the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) amendments. The OIG found OCR enforcement to be meeting Federal HIPAA requirements in some key areas, but to be wanting in others.
OCR enforcement activities meeting Federal requirements include, (1) making available guidance promoting compliance with the Security Rule; (2) the investigation process for responding to reported Security Rule violations; and (3) proper application of penalties for covered entities found in violation of the Security Rule. Continue reading
The Office of the Inspector General (“OIG”) issued a 2014-2018 strategic plan including outlining the visions, goals, and priorities of that office for the upcoming several years. The plan sets forth four goals: 1. Fight fraud, waste and abuse; 2. Promote quality, safety, and value; 3. Secure the future; and 4. Advance excellence and innovation. Each goals is identified with several priority areas that support the stated goal. The report can be found at the OIG’s website http://go.us.gov/WdbV
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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 residents were hospitalized for at least one day in federal fiscal year 2011. The study also reports that Medicare costs for nursing home residents represent 11.4% of the Medicare Part A spending on all hospital admissions during that same year resulting in Medicare paying $126 billion for those stays. Interestingly, high hospitalization rates were not evenly distributed throughout the country and generally nursing homes with lower CMS quality ratings had higher hospitalization rates. OIG recommends to CMS the development of a quality measurement report hospitalization rates for residents in each nursing home and to publicly report such measures. You can find a copy of the study here —> SNF Hospitalization Study
Posted in Acute Care, Health Care, Health Care Providers, Long Term Care, Medicare, Nursing Facility, Nursing Home, OIG, OIG Reports, Skilled Nursing Facility, Survey and Certification Letters
On November 6, 2013, CMS issued Transmittal No. 1311 which instructed Medicare Administrative Contractors (“MACs”) to reject claims for SNF to SNF ambulance transfers that are billed separately under Part B. According to CMS, ambulance transportation and related ambulance services for residents in a Part A stay are included in the SNF PPS rate and may not be billed as Part B services by the supplier. Instead, the SNF discharging the beneficiary to another SNF is responsible for the transportation fees. As such, ambulance providers must seek payment from the transferring SNF. Continue reading
Posted in Ambulance, CMS Transmittals, Continuing Care, Health & Human Services, Health Care, Health Care Providers, Long Term Care, Medicare, Nursing Facility, Nursing Home, Post Acute Care, Program Integrity, Regulatory Compliance, Skilled Nursing Facility, Transportation
On October 30, 2013, the New York State Office of the Medicaid Inspector General (“OMIG”) issued a press release that New York recovered $211 million from the federal government out of an identified $496 million in Medicaid erroneous payments related to home care recipients who are dually eligible for both Medicare and Medicaid funds. On October 1, 2013, the New York State Department of Health’s Fiscal Group received the $211 million payment through the action of OMIG, which was the largest single monetary recovery in OMIG’s history.
These payments were recovered by New York State as part of a federal project, the Third-Party Liability Home Health Care Demonstration Project, which is reviewing home health care involving dual eligible recipients, and is being conducted in conjunction with the University of Massachusetts Medical School. Continue reading
Posted in DHHS, Health & Human Services, Health Care, Home Health, Long Term Care, Medicaid, Medicare, New York, Nursing Facility, Nursing Home, Participation, Participation, Payers, Reimbursement, Skilled Nursing Facility
Tagged Centers for Medicare and Medicaid Services, CMS, Home Health, Medicaid, Medicare, New York, Nursing Home, OMIG, Skilled Nursing Facility, SNF
A former Florida nursing assistant pleaded guilty to wrongfully disclosing protected health information of residents in an assisted living facility. Denetria Barnes and Jakiel Bazart stole HIPAA protected records and sold the individual’s names, birth dates and social security numbers. An undercover sting with the cooperation of a number of law enforcement agencies caught the pair attempting to sell information for approximately 400 individuals for $15,000. A Florida district court judge has ordered restitution of $12,000, a sentence of 37 months in prison followed by 3 years of supervised release.
More information can be found at the US Department of Justice website http://www.justice.gov.
USA Today recently published a report about theft from nursing home resident trust funds by facility employees. According to USA Today’s analysis of data from the Centers for Medicare and Medicaid Services (“CMS”), more than 1,500 nursing homes have been cited since 2010 for mismanaging trust funds—of the more than 100 thefts identified, at least 10 exceeded $100,000. The report warns about inadequate oversight, at both the nursing home and state surveyor level, to effectively protect the integrity of resident funds from employee theft. Continue reading