Healthcare Financial News

The Centers for Medicare and Medicaid Services’ (CMS) had added significant information to its Nursing Home Compare web site; for the first time, information about nursing homes on the web site will list whether a home is or has been on CMS’s special focus facility (SFF) list. The agency’s SFF initiative gives heightened scrutiny to nursing homes that have a history of poor performance or repeated violations of state and federal health and safety rules.

The SFF initiative was created because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. As of this month, there are 134 SFFs, out of about 16,000 active nursing homes.

Nursing homes that have the SFF designation, including information about that designation, will now be noted on Nursing Home Compare. The web site will be updated with new information quarterly. Read the background information.

The Deloitte Forensic Center reports that complying with federal statutes and regulations continues to get more complex for hospitals. Regulations intended to address perceived abuse of Medicare and Medicaid spending keep growing in scope and in disclosure requirements as public officials strive to address different varieties of healthcare fraud. Regulatory agencies estimate that fraud and self-dealing could be costing Medicare and Medicaid as much as $200 billion per year.

Additionally, last September regulators announced a new information-collection program requiring about 500 hospitals to file comprehensive reports on their contractual relationships with physicians. The program imposes stiff penalties ($10,000 per day) for late filings. Also, there will be much more scrutiny of the contractual relationships that physicians have with hospitals, other health systems, imaging centers, durable medical equipment suppliers, and other health professionals--which will take more careful effort on the part of hospitals and their senior management. The timing of this requirement is still unknown.

To help clarify the issue, the Deloitte Forensic Center prepared a summary of the federal anti-kickback and physician self-referral statutes that have generated a number of government investigations. Read the article.