FRAUD

Bookkeeper Convicted of Stealing from Trust Fund Accounts of Patients: A bookkeeper at a nursing home in Birmingham, Alabama was convicted of first degree theft and computer tampering after stealing $4,068 from resident accounts. The bookkeeper allegedly tampered with electronic accounts by listing her co-conspirators as family members of the residents and writing checks to them, and has been ordered to pay full restitution. For more information, visit http://www.mcknights.com/news/nursing-home-bookkeeper-convicted-of-stealing-4000-from-resident-accounts/article/436544/

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CMS

On August 13, 2015, CMS announced that 2,100 participants of its Bundled Payments for Care Improvement pilot program (BPCI) had moved to the contract, risk-bearing phase of the program. This phase includes 1,071 skilled nursing facilities and 101 home health agencies in addition to other participants. According to a July 12, 2015 article published in McKnight’s, bundled payments for hip and knee replacements in particular could threaten referrals to skilled nursing facilities with 1 or 2 star ratings. Under the bundled payment system, hospitals will be choosing their partners more carefully and making sure that they refer to “medically advanced facilities that can handle bundles with a high quality of care”. See http://www.mcknights.com/news/cms-announces-participants-in-bundled-payment-pilot-program/article/432911/ and http://www.mcknights.com/news/bundled-payments-for-hip-knee-replacements-would-put-pressure-on-snfs/article/425885/.

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EMPLOYMENT

Workplace Violence Bill Proposed in MA: The Massachusetts Nurses Association has been pushing for a bill focusing on workplace violence prevention while citing statistics stating that healthcare workers, specifically female nurses, are at a high risk of violence by patients or their family members. While there is no federal requirement for such a law, many states independently require workplace violence programs. Requirements of the proposed MA bill include the development and implementation of workplace violence programs, annual risk assessments, and the creation of an in-house crisis response team. For more information, visit http://www.mcknights.com/news/state-bill-geared-toward-preventing-healthcare-workplace-violence/article/427949/

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DISCRIMINATION (NON-EMPLOYMENT)

ADA Settlement: A Virginia nursing home has agreed to pay $97,500 to settle allegations that it violated the Americans with Disabilities Act. The complaint stems from a 2014 incident in which two deaf visitors claimed that the nursing home failed to provide them with aids to communicate with a family member who was a resident of the facility. Under the settlement, the nursing home is also required to train staff on relevant parts of the ADA. For more information, visit http://www.mcknights.com/news/nursing-facility-agrees-to-97500-disability-act-settlement/article/427696/

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FRAUD/ABUSE

Settlement Reached Following Anti-Kickback and Stark Law Violations: The Westchester Medical Center (WMC) has agreed to a settlement in which they will pay $18.8 million and admit to illegal conduct in violation of the Anti-Kickback Statute and Stark Law. WMC was involved in a financial relationship with Cardiology Consultants of Westchester, P.C. (CCW) in which they provided money to CCW in exchange for referrals. Visit http://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-settles-civil-fraud-claims-against-westchester-medical-center for more information.

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FRAUD/ABUSE

Three Sentenced in Medicare Fraud Scheme: According to the Department of Justice, a former hospital president and two co-conspirators were sentenced for their contribution to a Medicare fraud scheme. From 2005 to 2012, the three defrauded Medicare of $158 million by billing for services that were not provided. The former president was sentenced to 45 years in prison and ordered to pay $46,753,180 in restitution; the others received sentences of 20 years and $7,518,480 restitution, and 12 years and $46,255,893 restitution for their roles in the scheme. For more information, visit http://www.justice.gov/opa/pr/former-president-riverside-general-hospital-sentenced-45-years-prison-158-million-medicare Read more…

FRAUD/ABUSE

Payroll Scam: Two employees of a Pennsylvania nursing home have been charged with stealing $144,000 from the facility in a payroll scheme that ran from January 2012 to April 2015. According to McKnight’s Long-Term Care News, an employee who created schedules for the facility added additional hours to another employee’s payroll sheets for time that was not worked. The two then split the extra money. To view the McKnight’s article, visit http://www.mcknights.com/news/two-employees-charged-in-alleged-144000-nursing-home-payroll-scam/article/417016/

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FRAUD/ABUSE

1. Anti-Kickback Violations: According to McKnight’s Long Term Care News, a pharmacy services company in North Carolina has agreed to pay a civil fine of $5 million to resolve anti-kickback violations. The U.S. Attorney for the Eastern District of North Carolina stated that the prior owners of the pharmacy allegedly offered monetary rewards to Medicare and Medicaid beneficiaries for enrollment or referrals. The McKnight’s Long Term Care News article can be found at http://www.mcknights.com/news/new-pharmacy-owner-agrees-to-5-million-settlement-in-anti-kickback-case/article/413524/

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FRAUD/ABUSE

1. Anti-Kickback Violations: According to McKnight’s Long Term Care News, a pharmacy services company in North Carolina has agreed to pay a civil fine of $5 million to resolve anti-kickback violations. The U.S. Attorney for the Eastern District of North Carolina stated that the prior owners of the pharmacy allegedly offered monetary rewards to Medicare and Medicaid beneficiaries for enrollment or referrals. The McKnight’s Long Term Care News article can be found at http://www.mcknights.com/news/new-pharmacy-owner-agrees-to-5-million-settlement-in-anti-kickback-case/article/413524/

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