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
The U.S. 6th Circuit Court recently upheld a DHHS Departmental Appeals Board decision that found a skilled nursing facility’s (“SNF”) deficiencies were at an “immediate jeopardy” level relating to a failure to notify a physician or family member of a significant change in a patient’s condition. See, Claiborne-Hughes Health Center v. Sebelius, 6th Cir. No 09-3239, 6/25/10.
The Claiborne-Hughes Health Center is a SNF in Franklin, TN. The decision was based upon surveyors findings that the facility failed to comply with 42 C.F.R. §483.10(b)(11). Section 483.10(b)(11) requires a facility to immediately consult with a resident’s physician and notify the resident’s family members or legal representation when there is a significant change in a resident’s physical, mental, or psychosocial status.
The failure to comply with the applicable regulation related to Claiborne-Hughes’ policy on recording patient fluid-intake. Surveys completed in August and September of 2006 revealed that the facility was not sufficiently monitoring patient fluid intake in accordance with its own policies.
A copy of the decision can be found at – http://caselaw.findlaw.com/us-6th-circuit/1529702.html
Posted in Civil Litigation, DAB Decisions, Health Care, Health Care Providers, Nursing Home, Participation, Post Acute Care, Tennessee
Tagged ALJ Decisions, Certification, CMS, Conditions of Participation, Departmental Appeals Board, Immediate Jeopardy, Medicaid, Medicare Enrollment, Nursing Home, Skilled Nursing Facility, SNF