Medicare Compliance & Reimbursement

Nursing homes face possible fines of $50,000 or more.
 
The feds and many states are putting new muscle into their efforts to boot poor-performing nursing homes out of business. But the real kicker is this: The policies and procedures SNFs think will protect them may bring them down. The problem for many providers is implementing what amounts to a tangle of compliance-related policies and procedures, offers Reta Underwood, president of Long Term Care Consultants, Inc. in Louisville, KY. "If you have a four-inch thick binder sitting on a shelf, chances are no one on staff is going by the book," she explains. "You've made compliance too complicated.
 
"Hand a surveyor a manual like that and you've just handed them more evidence [of noncompliance]," quips Underwood.
 
What's at stake? In addition to fines related to survey compliance, nursing homes face the prospect of settlements that could lead to additional fines of $50,000 or more - plus the costs of setting up and administering a government-mandated corporate compliance program.
 
Case in point: Majestic Oaks, a 180-bed nursing facility just resolved charges that the facility didn't do enough to prevent pressure ulcers and other wounds. The facility also faced charges of inadequate care and management of falls.
 
The owners, who deny any intentional misconduct, have agreed to pay $50,000 to the government, set up a $25,000 fund that must be used within one year to purchase services or equipment to enhance the quality of care, pay and use independent third-party compliance consultants for one year and adhere to a corporate compliance program that dictates how to report and address all aspects of care.