Posts Tagged ‘Department of Health and Human Services’

Fazzi Associates: New National Average Case Mix Weight

August 1, 2013

Question: We saw the Minute in the Morning email with a preliminary case mix weight of 1.3517, up from 1.27.  Can you tell me more about it and what that means for my agency? (more…)

CMS Imposes First Affordable Care Act Enrollment Moratoria to Combat Fraud

July 26, 2013

Building on strong anti-fraud efforts already underway, Centers for Medicare & Medicaid Services’ Administrator Marilyn Tavenner today announced temporary moratoria on the enrollment of new home health provider and ambulance supplier enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three fraud “hot spot” areas of the country, including two Florida counties. The goal of the temporary moratoria is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and CMS is exercising this authority for the first time.

Under the moratoria, existing providers and suppliers can continue to deliver and bill for services, but no new provider and supplier applications will be approved in these areas for all three programs. The temporary enrollment moratoria apply to newly-enrolling home health agencies in the Miami and Chicago metropolitan areas; and newly-enrolling ground ambulance suppliers in the Houston metropolitan area (see list of affected counties below). CMS announced the temporary, six-month moratoria in a notice issued today in the Federal Register. (more…)

U.S. Intervenes in False Claims Act Lawsuit Against Fla. Home Health Care Company and Its Owner

July 22, 2013

The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services. (more…)

Call for Nominations: Seeking FL Home Care Nurses to Serve on National Advisory Council

July 2, 2013

The Health Resources and Services Administration (HRSA) is requesting nominations to fill seven vacancies on the National Advisory Council on Nurse Education and Practice (NACNEP). The NACNEP advises and makes recommendations to the Secretary of the U.S. Department of Health and Human Services and Congress on policy matters arising in the administration of Title VIII including the range of issues relating to the nurse workforce, nursing education, and nursing practice improvement.

The Advisory Committee may make specific recommendations to the Secretary and Congress regarding programs administered by the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, particularly within the context of the enabling legislation and the Division’s mission and strategic directions, as a means of enhancing the health of the public through the development of the nursing workforce. The Advisory Committee provides advice to the Secretary and Congress in preparation of general regulations and with respect to policy matters in the administration of this Title including the range of issues relating to the nurse supply, education, and practice improvement. The Advisory Council shall annually prepare and submit to the Secretary; the Committee on Health, Education, Labor, and Pensions of the Senate; and the Committee on Energy and Commerce of the House of Representatives, a report describing the activities of the Advisory Council including its findings and recommendations. (more…)

Fraud-Fighters Being Laid Off

July 1, 2013


Florida, one of the nation’s hotspots for Medicare and Medicaid fraud, is at particular risk as budget changes in Washington combine to force the layoff this year of 400 employees of the Inspector General’s office at the Department of Health and Human Services.

The Center for Public Integrity reports that the staff-shedding began in January and resulted in 1,200 complaints going without investigation last year. The sequester – automatic across-the-board cuts that went into effect because of Congress’ inability to resolve its internal disputes – is only part of the reason. (more…)

Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

June 25, 2013

By Susan Jaffe, Kaiser Health News

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage – unless the problem got worse, in which case the treatment could resume.

This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage. (more…)

Sarasota Herald Tribune: Nation at Crossroads in Home Care for Elders

May 28, 2013

By , Sarasota Herald Tribune

Chuck and Rosalie Schockweiler need no words as they execute a smoothly choreographed routine in their Englewood home.

He rinses her feeding tube and hands it to her; she shakes it dry and attaches it to a port on her abdomen as he dissolves three pills in water. Chuck fetches her liquid lunch as Rosalie places a plastic receptacle in an ingenious homemade stand that Chuck fashioned from PVC pipe and an old battery charger, weighted “with imported stones from the front yard.”

He pours in the solution, and as she feels it flow into her belly, she smiles — the same glorious, sunny smile he first noticed back when they worked at Venice Regional Medical Center. He chases the meds with a can of liquid nutrition Rosalie must have five times daily, filling the tube and responding to her prompt when it’s time for another pour.

Usually, as Rosalie finishes her meal, Chuck gets himself something to eat and they sit together at the dining table. Then they stand, every single time, for a long, satisfying hug.

It’s a process they repeat about every two and a half hours, with two more feeding sessions for medication alone.

Early in the day, it looks easy. But, Chuck admits, evenings are tougher because his energy flags. (more…)

Elizabeth Hogue on New HIPAA Rules: Breach Notification (Part 5)

May 28, 2013

The U.S. Department of Health and Human Services (HHS) has issued final rules to:

  • Modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules to implement statutory amendments under the Health Information Technology Economic and Clinical Health Act (HITECH Act) to strengthen the privacy and security protection for individuals’ health information;
  • Modify the rule for Breach Notification for Unsecured Protected Health Information (Breach Notification Rule) under the HITECH Act to address public comments received on the interim final rule;
  • Modify the HIPAA Privacy Rule to strengthen the privacy protections for genetic information by implementing section 105 of Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA); and
  • Make other modifications to the HIPAA Privacy, Security, Breach Notification and Enforcement Rules to improve their workability and effectiveness, and to increase flexibility and decrease burden on regulated entities.

The final rules were published in the Federal Register on January 25, 2013, and will be effective on March 26, 2013. Covered entities and business associates must comply with the final rules by September 23, 2013. This is the fifth in a series of articles that will address key provisions of the rules, their impact on post-acute providers, and practical solutions for compliance. (more…)

Government’s Aim to Decrease Number of Disabled People in Nursing Homes

May 22, 2013

19219705The federal government is ramping up efforts to reduce the number of disabled people in nursing homes through interagency initiatives.

Under the Americans with Disabilities Act of 1990 and a subsequent U.S. Supreme Court decision, it is considered discrimination to “segregate” disabled people in nursing homes or other traditionally institutional settings. While many disabled people have already been moved out of nursing homes, a sharper focus is needed because the aging of the baby boom generation will increase the number of seniors with disabilities, the Education Department said in the Federal Register article. (more…)

Medicare Fraud Strike Force Charges 89 Individuals for $223M in False Billing

May 15, 2013

medicare fraudAttorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. Florida accounted for 34 of the arrests made.

This coordinated takedown was the sixth national Medicare fraud takedown in Strike Force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. (more…)