Long Term Care & Senior Living Blog

The Office of Inspector General (OIG) recently released the findings of an audit performed to determine the prevalence of incidents of potential abuse or neglect of Medicare beneficiaries residing in skilled nursing facilities (SNFs). Specifically, OIG looked at beneficiaries who resided in a SNF during 2016 and who also had a hospital emergency room (ER) Medicare claim containing a high-risk diagnosis code. 

In light of concerns that patient photographs are showing up on social media networks and other multimedia messaging, CMS issued guidance to State Survey Agency Directors. S&C: 16-33-NH dated August 5, 2016, effective immediately, addresses the need for nursing homes to protect residents’ privacy. CMS stresses the importance to recognize each resident’s sense of self-worth and to create a respectful environment.

The Justice Department is committed to combat fraud and abuse in federal healthcare programs. The most recent complaint filed by the DOJ is against Midwest Neurosurgeons LLC and its owner, Dr. Sanjay Fonn, MD, along with DS Medical LLC and its owner, Deborah Seeger. The defendants allegedly violated the Anti-Kickback Statute and False Claims Act by conspiring to solicit and receive commissions from medical device manufacturers related to the implant of spinal implants and supplies used for spinal fusion surgeries.

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it.

While the donation of a valuable item such as an EHR program would raise fraud and abuse concerns, exemptions under Stark Law and Anti-Kickback Safe Harbor were designed to encourage the widespread implementation of EHR and to let smaller providers accept gifts of EHR software without violating the law or statute.