Table of Content
"We want to make sure providers spend time caring for residents instead of completing unnecessary paperwork." Power outages are directly linked with adverse outcomes among nursing home residents — many of whom are dependent on electric health care equipment and struggle to tolerate temperature fluctuations, according to the study. As a result of the alleged fraud financial abuse and unnecessary staffing cuts, residents at the rehab center suffered badly and needlessly during the COVID-19 pandemic, the lawsuit states. Just a month before the pandemic struck, the owner of the facility devised a plan to cut $1.6 million from the budget by reducing staff — even though the Department of Health said all nursing homes needed to prepare for the coming pandemic. An investigation by James' office found that the facility's owners diverted $22.6 million in Medicaid and Medicare funds from resident care through a network of 13 companies that were used to conceal profit-taking.
Providers should also use objective, clear, clinical quality data—such as from The Post-Acute Pathways Explorer—to ensure a common starting point on facility performance. The program provides housekeeping, meal preparation, bathing, toileting, and grooming services. For Medicaid-eligible persons, local social services districts usually contract with home-care agencies that employ aides to provide Medicaid-funded personal care services.
The Quotes That Defined Skilled Nursing in 2022 — and Hint at What’s Ahead
With the lawsuit, Ms. James seeks to prevent new resident admission, install monitors to oversee the facility's operations and finances, and ban existing or hidden owners from their roles. Among the examples noted in the lawsuit, a diabetic man was given a wheelchair without footrests, forcing him to drag his feet on the floor — leading to sores. Part of his toe had to be amputated at the hospital as a result of the infections, and not long after he returned to the center, he died, the investigation found.
The person looking after him was not told when the man died, or even was informed of his condition after going back to the facility. Top Management ChallengeOIG annually identifies top management and performance challenges HHS faces as it strives to fulfill its mission. In addition to fraud, the Brooklyn-based agency was also cited for cheating aides out of their wages. Engaged in a $2 million fraudulent promissory note scheme when purchasing the facility. New York Attorney General Letitia James sued Cold Spring Hills Center for Nursing Rehabilitation in Woodbury for allegedly diverting over $22.6 million in Medicaid and Medicare funds to the owners' pockets.
Promote Emergency Preparedness and Response Efforts
To be eligible, a participant has his or her doctor send a completed Physician´s Order to the local social services district, which then arranges a social and nursing assessment of the individual. A nurse assessor uses the results of the assessments and the physician’s order to recommend an appropriate amount, frequency and duration of services. If you are eligible and have an immediate need for Personal Care Services, more information is available here. In another instance, federal officials categorized the rape of a resident by a staff member at a nursing home in San Diego as a "category F" violation, which designates a lower-level issue that causes "potential, not actual, harm"—and enabled that facility to hold on to its five-star rating. In fact, according to the Times, inspectors determined that incidents of sexual abuse in at least 40 other facilities with five-star ratings did not comprise actual harm or put residents in "immediate jeopardy."
HHS is requesting an additional $45 million in the FY 2020 budget to strengthen nursing home enforcement. "We're also committed to working with Congress to strengthen nursing home enforcement. The FY 2020 Budget also requests $442 million for Survey and Certification, a $45 million increase from the previous year," she said.
‘They Tried to Kill Me': Neglect, Abuse and $22M Fraud at NY Nursing Home, AG Finds
“The medical complexity and functional needs of nursing home residents render them susceptible to disproportionate harm from exposure to environmental hazards,” the authors concluded. SEAL team commander found dead in California residenceAmtrak suspending some service due to massive winter stormSuch a response could be governed by emerging health care coalitions — regional partnerships that integrate emergency planning, health care and public health organizations, the researchers explained. Despite being located in fire-prone regions, these nursing homes demonstrate poorer compliance with Medicare’s emergency readiness standards, according to the study, published on Wednesday in the Journal of the American Geriatrics Society. When Jordyn's not covering the latest skilled nursing news, she's likely catching a Cubs game at Wrigley Field, cheering on the Iowa Hawkeyes or watching Gilmore Girls all the way through for the millionth time.
These audits help reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS. We help leaders and future leaders in the health care industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution. In addition, the Times gained access to ratings information typically not made public from academics who, via research agreements with CMS, had access to such data. Verma pledges to improve transparency, quality and compliance without undue paperwork burdens on nursing homes. CMS is developing quality measures that score providers based on patient outcomes, not adherence to processes, Verma said. "I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes," she said.
HHS Office of Inspector General
Ultimately, the Times' investigation found the Covid-19 fatality rate at five-star facilities was just half a percentage point lower than at facilities with lower ratings—and in fact, the fatality rate was slightly lower at two-star facilities than at four-star facilities, the Times reports. The Centers for Medicare & Medicaid Services has launched a review of regulations and processes governing safety and quality of care in the nation's nursing homes, Administrator Seema Verma said. It will still be subject to Medicaid estate recovery, but the net rental income would go to the nursing home, reducing Medicaid’s outlay and ultimate estate recovery claim.
According to the Times, this analysis depended in large part on nursing homes' self-reported data from January 2020, which was submitted before the novel coronavirus pandemic temporarily altered how data is submitted, as well as payroll and cost report data from 2019. To assess how star ratings changed over time, the Times examined quarterly ratings and metrics through 2015. As an example of how this system can affect overall star ratings, the Times cited a nursing home in Florida, which in early 2019 had a two-star rating for its staffing. However, in the second half of 2019, the facility reported a dramatic increase in nursing hours—supplied entirely by the addition of administrative nursing staff—and by January 2020, the facility had a five-star rating, the Times reports. CMS fines nursing homes that don’t comply and the agency recently launched an initiative to invest these Civil Money Penalty dollars in efforts to reduce adverse events, improve staffing quality and improve quality of care for residents with dementia.
For instance, the Times reports that the rating system requires facilities to report the prescription medication they administer to residents and penalizes nursing homes that overuse certain medications. However—based on court documents and interviews with administrators, nurses, and federal officials—nursing homes "for years have underreported the number of residents" using opioid and antipsychotic medication. CMS has also increased public awareness of nursing homes failing to meet our minimum health and safety standards. "Now, instead of publishing notices in local newspapers, we're publicizing instances in which CMS terminates our agreements with nursing homes due to poor quality on our website," Verma said. "While we support and promote the private sector's critical role in our healthcare system, CMS' duty to monitor the safety of the nation's hospitals, nursing homes, and other providers, is a unique governmental task which lies at the core of government's role in healthcare," Verma said in a media release. The poorer emergency preparedness at high-risk nursing homes suggests, however, that staff members may be either unaware of or not adequately incentivized to respond to wildfire risk, the authors explained.
To protect residents, OIG continually assesses nursing home performance and oversight, monitors the impact of program changes, and uses our enforcement tools to address misconduct. Between 2017 and 2019, health inspectors wrote up an estimated 5,700 nursing homes—accounting for more than 33% of all nursing homes in the country—for misreported data on residents' wellbeing, including nearly 800 homes with high overall scores. But even when such misreporting was discovered, the Times reports, federal auditors didn't more closely review all the data that those homes had submitted to CMS. Once calculated, the overall star rating—as well the individual scores for in-person inspections, staffing, and care quality—are posted to CMS' Care Compare website.
That staffing problem has continued through 2022, according to the attorney general's office. During the first few months of the pandemic, from March to June of 2020 when nursing home staffing across the country was stretched beyond thin, 166 Cold Spring Hills residents died, 98 of which were from COVID. The facility failed to report 51 of those deaths to the state's DOH, the lawsuit stated, a fraudulent underreporting by more than 50 percent. A Long Island nursing home is under fire from the New York attorney general's office after troubling, jaw-dropping allegations surfaced regarding abysmal patient care and a $22 million fraud by the owners of the facility.
Medicare Advantage insurers and other managed care organizations have incentives to favor lower-cost home health care versus skilled nursing facility care, as they seek to deliver services in settings that consumers prefer and at lower costs. This trend has been enabled by the creation of SNF-at-home models and other programs for delivering more advanced care in the home. However, SNF-at-home has been a slow-growing offering and is still in its early stages. The Centers for Medicare & Medicaid Services is taking steps to ensure that patients are not inappropriately denied coverage for post-acute care in particular settings — including skilled nursing facilities — by Medicare Advantage organizations .
No comments:
Post a Comment