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Medicare Compliance & Reimbursement

LONG-TERM CARE:

Florida Homes Under Quality-Of-Care Scrutiny

Published on Thu Apr 15, 2004

Sanctioned facilities should beware of pocketing payments for new admits

Is improper Medicaid funding still being tapped despite a denial of payment remedy? The HHS Office of Inspector General took a gander Feb. 27 at sanctioned facilities in the Sunshine State and says it wants a tighter hand on the controls.
 
An audit of 100 sanctioned homes did reveal that the mandatory denial of payment remedy, which is imposed on homes that run afoul of quality of care standards, was in good shape - 31 homes were still on the receiving end of $99,957 in unallowable Medicaid payments, according to the report, titled "Nursing Homes and Denial of Payment Remedies in the State of Florida" (A-04-03-06007).
 
The problem? No mechanism is in place to catch payments for residents who were admitted after sanctions were put into effect.
 
Florida agreed with the OIG's request for both a financial adjustment and better edits in place to stem future payments to new admits in ineligible homes.
 
To read the report, go to: http://oig.hhs.gov/oas/reports/region4/40306007.pdf.

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