Medicare changed the rules for paying skilled nursing facilities in hopes of reducing waste, fraud, and abuse. Instead of rewarding therapy volume, the new payment model placed more weight on patient diagnoses and clinical complexity. That was the intent. A recent Forbes piece highlights what happened next: facilities began coding residents as having more illnesses
Two women have been indicted on multiple health care fraud-related charges for allegedly providing medical services without proper credentials and improperly billing the Medicaid program. See article here. The indictment names Esney Davis-Sharpe, 63, of East Orange, New Jersey, who owned and operated the Bessie Mae Women’s Health Center, and Nataliya Lushchak, 48, of Lower
A federal investigation into UnitedHealth Group’s involvement in nursing home care highlights a dangerous tension that has been building in long term care for years: when financial incentives influence clinical decisions, residents are put at risk. U.S. Senators Ron Wyden and Elizabeth Warren are demanding greater cooperation from UnitedHealth after reporting and whistleblower accounts raised
Too many skilled nursing facility residents are being misled about their rights, and it’s happening for a very simple reason: money. Recent reports show that some SNFs are telling residents they will lose their Medicare coverage if they leave “against medical advice” or before a certain number of days. That claim is false. Residents are
John Oliver satirizes Medicare Advantage and exposes both the systemic shortcomings of this insurance industry-created monstrosity, and its, er, disadvantages for consumers: https://www.youtube.com/watch?v=Ejoi9yfLVCc
McKnight’s reported that the Trump Administration has changed the rules in how nursing homes can charge patients and their family members. CMS, the overseer of Medicare and Medicaid, will protect families from having to pay when vulnerable adults lose coverage or run out of money. In the past, nursing homes were permitted to demand money from family
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