On November 3, 2022, Gov. Tom Wolf (D) signed into law House Bill 2293 which created new oversight of and accountability for temporary health care staffing agencies operating in Pennsylvania’s assisted living communiti...
Provider Directory Accuracy – Health Plans’ Continuing Challenge
In 2018, CMS released a report that set forth the results of their review of Medicare Advantage online provider directories. The review examined the accuracy of 108 providers and their listed locations selected from the ...
Enhancing Healthcare Compliance: Strategies for Program Improvement in a Changing Landscape
Conferences always provide food for thought and tips for how to think more deeply about my Compliance program and especially how to improve it. The Healthcare Compliance Association Compliance Institute held in April 202...
The High Cost of Inaccurate Provider Enrollment for Nursing Homes
As providers of Medicare services, nursing homes rely heavily on the timely and accurate reimbursement from the government to ensure the provision of top-quality care to their residents. The negative financial implicatio...
CMS’ Home Care Compare Website to Display Disputed Survey Citations Prior to Resolution
CMS issued a memorandum regarding changes to the Nursing Home Care Compare website. Of particular note for home care facilities is the posting of preliminary survey findings of nursing facilities prior to final resolutio...
More CCO Skin in the Game Moving Forward
Chief Compliance Officers (CCOs) routinely take point on reaching resolution with state and federal regulators when addressing and settling cases related to regulatory or compliance violations. However, in 2022, the US D...
OIG’s Evolving Integrity Agreements
Recently, the OIG modified the provisions and requirements of several corporate integrity agreements (CIA). In addition to having direct impact on those organizations subject to such agreements, these changes also provid...
Updated Guidance on Exclusion Screening for New Jersey’s Medicaid Providers and Plans
In January of 2023, New Jersey issued new guidance regarding those databases that healthcare entities (including providers and managed care organizations) participating in NJ’s Medicaid program must query monthly to ve...
Recent Additions to California’s Medi-Cal Exclusion Screening Databases
The California Medicaid program, known as Medi-Cal, is a highly regulated program by any measure. California takes a very intensive approach to assure that organizations offering services to Medicaid recipients meet a ve...