New supplemental compliance program guidance (CPG) for nursing facilities, published in the Sept. 30 Federal Register, is intended to help nursing facilities develop compliance programs that address major Medicare and Medicaid fraud and abuse problems related to poor quality of care, billing federal healthcare programs, and kickbacks. The new CPG responds to developments in the nursing facility industry, including significant changes in the way nursing facilities deliver and receive reimbursement for healthcare services, evolving business practices, and changes in the federal enforcement environment.
A goal of the new CPG is fostering quality of care in nursing facilities. The CPG will help compliance professionals address areas such as staffing, resident care plans, medication management, appropriate use of psychotropic medications, and resident safety. The new guidance also emphasizes the importance of submitting accurate claims and discusses issues related to reporting resident case-mix data, therapy services, screening for excluded individuals and entities, and restorative and personal care services. The guidance also urges nursing facilities to consider the risks of improper kickback payments associated with their business arrangements, including those involving free goods and services, as well as those with physicians and suppliers. Download the CPG.
