Nursing homes to face tougher federal scrutiny
Nursing homes to face tougher federal scrutiny
Nursing homes should brace for tough government scrutiny on a number of fronts, including quality of care and payment for Part B therapy. Last week, the Eastern District of Pennsylvania claimed its sixth nursing home victim when it announced a $60,000 settlement with Ashton Hall Nursing and Rehabilitation Center in Philadelphia. Notably, the case was based on the government's charge that Ashton Hall provided inadequate nutrition and wound care involved care provided to a single resident in 1998, reports Assistant U.S. Attorney David Hoffman.
Similar to earlier agreements, the remedy imposed on Ashton Hall includes monitoring and fines. However, the facility also was required to create a minimum $100,000 fund over the next two years devoted to improving quality of life and environmental factors at the facility. Hoffman says his office will have input into how that money is spent.
The quality-of-care threat facing nursing homes is by no means limited to the Eastern District of Pennsylvania. While that U.S. attorney's office has spearheaded this concept, Hoffman predicts that similar cases will emerge in a number of other districts.
"The whole quality-of-care issue as far as the False Claims Act is concerned is continuing to gather steam," warns health care attorney Marie Infante of the Washington, DC, office of Mintz Levin. According to Infante, Medicaid fraud units and attorneys general are also beginning to look at this issue.
Quality of care isn't the only threat looming for nursing homes, however. In a report released last week, the Department of Health and Human Services Office of Inspector General (OIG) recommended that the Health Care Financing Administration (HCFA) make sure that adequate medical reviews of Part B therapy in nursing facilities are conducted and that therapy providers understand billing procedures and medical necessity guidelines.
While the report was mandated by Congress, Infante says nursing homes should take note. "If I was a nursing home, I would assume that all Part B therapy is going to be scrutinized very carefully," she says. "The OIG has a history of being deeply suspicious of therapy in nursing homes."
The OIG points out that implementation of monetary caps on therapy services in skilled nursing facilities (SNFs) coincided with a dramatic decrease in Part B therapy charges last year. But the OIG says that preliminary reports indicate that a rebound in SNF Part B therapy charges should be expected over the next two years.
It attributes part of that increase to inadequate contractor oversight of billing practices and medical necessity of Part B therapy.
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