Medicare Compliance & Reimbursement

Nursing homes that fail to establish solid programs to ensure quality of care could very well end up having such programs imposed on them. As state and federal prosecution of "failure of care" cases heats up, nursing homes are more and more often compelled, as a condition of settling the cases, to implement aggressive quality-oriented compliance programs. In one recent example, a Hobbs, NM nursing home entered into such an agreement with the New Mexico attorney general's office. AG Patricia Madrid says Country Cottage Care and Rehabilitative Center failed to provide services that met minimum quality standards, and improperly collected Medicaid payments for the inadequate care. In settling the case, the nursing home will pay $25,000 back to the Medicaid program. But that's not the meat of the settlement. To resolve the AG's case, Country Cottage also agreed to a two-year quality agreement designed to ensure better training for caregivers, nurses and food services workers; improved safety for patients who wander; and better medical oversight. Lesson Learned: The nexus between Medicare and Medicaid compliance and quality of care is growing ever tighter, so compliance officers should be attuned to the level of care being offered at their facilities.