Transparency

The Skilled Nursing News had a great article on how the pandemic has increased data collection. Hopefully, this will increase transparency to prevent fraud, and establish evidence-based best practices for quality care. Nursing homes report data to the federal government as required under federal regulations. Trump instituted these regulations as a result of the COVID-19 public health emergency.

Whistleblowers can bring lawsuits under the False Claims Act (FCA) and may recover damages afforded under the FCA. These cases relate to fraud and misconduct of private companies that do business with Medicare, Medicaid, and other public health care funding sources. These cases will be guided by the COVID-19 data nursing homes are required to submit to the government.

The DOJ in early March announced the creation of a specialized task force that would be investigating “grossly substandard care” in nursing homes. Both criminal and civil penalties were available for owners and operators. At the time of the March 3 announcement, the DOJ it would focus on operators with a history of fraud, abuse and neglect.

The ‘worthless services’ theory applies most often against nursing homes. The definition is based on the provider’s performance of services being so deficient that, for all practical purposes, it’s equivalent of providing no services at all.

The Office of Inspector General (OIG) is reviewing multiple facets of nursing home operations, including:

• Medicaid nursing home life-safety and emergency preparedness reviews
• Audits of nursing home compliance with COVID-19 reporting requirements
• Why COVID-19 had the effect it did on the hardest-hit facilities
• Infection prevention and control programs in nursing homes
• Nursing home oversight

Finally, quality of care is now “front and center” as a part of a the provision of services by nursing homes that are receiving Medicare and Medicaid reimbursements. Transparency helps everyone.