Articles and Blogs

On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million.  According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who were…Read More

On October 6, 2011, the Provider Reimbursement Review Board released Decision No. 2012-D1 ruling on two issues related to proper calculation of “total paid hours” when calculating the wage index for hospitals in Cincinnati and rural Iowa.  Both issues related to hour recorded as paid by the hospitals but not actually worked by employees.  In…Read More

Representative John Kline of Minnesota introduced the Workforce Democracy and Fairness Act last week in response to recent NLRB actions affecting employers.  One aspect of this Bill is the reversal of the NLRB’s Specialty Healthcare decision which altered the established standard for determining collective bargaining units in non-acute care health facilities.   

As previously discussed, hospice providers are required to have a hospice physician or nurse practitioner perform a face-to-face encounter with each hospice patient whose total length of stay is anticipated to reach the third benefit period.  This encounter must be performed no more than thirty days prior to the third benefit period recertification, and no…Read More

On October 5, 2011, the Office of Inspector General (OIG) published its proposed Work Plan for Fiscal Year 2012. As in the past, the Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The 2012 Work Plan contains several new areas of focus by the…Read More

After October 31, 2011, DMEPOS suppliers will no longer be permitted to use the 07/09 version of the CMS-855S application and will be required to utilize the updated 07/11 version. The 07/11 version is available and may be used for submissions now. The newest version of the application has been updated to capture additional information…Read More

The NLRB announced last week that it has postponed the implementation date for its new notice-posting rule (previously discussed here and here) by more than two months in order to allow for “enhanced education and outreach to employers”, particularly those who operate small and medium sized businesses.  The posting requirement for most private employers was…Read More

McKight’s points to a recent study that suggests nursing uniforms laundered at home have not been adequately sanitized.  The study from the University College in London found residential washing machines only heated water to 104 degrees Fahrenheit, leaving substantial amounts of bacteria behind. Investigators found that thorough ironing after washing was successful in removing remaining Acinetobacter and…Read More

Effective October 1, new PPS rules for fiscal year 2012 require nursing homes to diligently review claims prior to submission.  As previously discussed, significant cuts in SNF reimbursement are aimed mostly at therapy services.   SNFs submitting claims under the previous rules can expect high rates of denials and rejections.  Even facilities billing under the new rules…Read More

CMS has published a proposed regulation that would limit the ability of institutional pharmacies to offer pharmacist consultation services to facilities.  CMS believes that relationships between nursing homes and pharmacy suppliers could result in “recommendations that conflict with the best interests of nursing home residents.” The proposed regulation would require facilities to hire independent pharmacists to oversee…Read More