Medicare may impose penalties on a nursing home when there’s a serious health or fire safety citation or if the nursing home fails to correct a citation for a long period of time. There are 2 types of penalties (1) Fines: Fines may be imposed once per citation or each day until the nursing home corrects the citation. (2) Payment denials: During a payment denial, the government stops Medicare or Medicaid payments to the nursing home for new residents until the nursing home corrects the citation.
If the residential facility doesn’t correct these problems, Medicare will end its agreement with it. This means the residential facility is no longer certified to provide and be paid for care to people with Medicare or Medicaid. Residents with Medicare or Medicaid who are living in the home at the time of the termination will be moved to a different residential facility that is still certified by CMS. The penalties can be harsh, but you do not have to accept these penalties. You can defend your facility. This webinar will give you tools to do so.
For deficiencies that result in immediate jeopardy, a facility is subject to the appointment of temporary management to oversee operations while deficiencies are corrected or termination from the Medicare and/or Medicaid programs with the safe and orderly transition of residents to another facility or community setting. However, a facility may continue to receive Medicare and/or Medicaid payments for up to six months after a deficiency finding, if the state finds that this alternative is more appropriate than program termination. In these instances, the facility must agree to repay Medicare funds, and the state must agree to repay federal Medicaid funds if corrective action is not taken according to a Secretary-approved plan and timetable. For deficiencies that do not result in immediate jeopardy, a facility may be allowed up to six months to correct deficiencies. A facility that does not come into substantial compliance within three months is subject to denial of Medicare and/or Medicaid payment for all individuals admitted after the deficiency finding date. A facility that is not in substantial compliance within six months is subject to Medicare program termination and discontinuance of Medicaid federal financial participation.
This webinar will help you navigate the process of penalties and defending against them.
- Learn penalties available to CMS to incur on facilities
- Learn examples of situations that spur on penalties
- Learn the different type of residential facilities that may get penalties
- The Law of Penalties
- Exceptions or good cause for penalties
- Limitations to penalties
- Good defenses
- How to go through the process of getting investigated
- A facility’s rights
- Appeal rights
Areas Covered in the Session:
- Administrative law
- Penalties and why
- How to handle being investigated
- What facilities do these penalties apply to
- Facilities’ rights
- Good defenses to penalties
- Appeal rights
- Live Q&A Session
- Long term care facilities
- Residential Living Facilities
- Nursing Homes
- Skilled Nursing Homes
- Hospital executives
- Health Care Societies and Associations
- Health Care Attorneys
- Physician Groups
- Medical Provider
- Medical Practices
- Hospitals staff
- Compliance Officers
For more than 20 years, Knicole has maintained a healthcare litigation practice, concentrating on Medicare and Medicaid litigation, healthcare regulatory compliance, administrative law, and regulatory law. She understands the intricate Medicare and Medicaid payment system, the unique business of healthcare providers, the overlay of federal and state Medicare and Medicaid rules and regulations, and the actions of state agencies that affect the way healthcare entities operate. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards. Knicole has successfully obtained federal injunctions in numerous states, which allowed healthcare providers to remain in business despite the state or federal laws’ allegations of healthcare fraud, abhorrent billings, and data mining. Across the country, Knicole frequently lectures on healthcare law, the impact of the Affordable Care Act, and regulatory compliance for providers, including physicians, home health and hospice, dentists, chiropractors, hospitals, and durable medical equipment providers. She is a weekly panelist on RACMonitor, as a national expert on Medicare and Medicaid audits. Prior to joining Practice, Knicole was Co-Chair/Managing Partner of the Healthcare Practice with Gordon & Rees and served as North Carolina Assistant Attorney General in the Health and Public Assistance Section where she gained a thorough understanding of the Medicaid system that informs her practice today.
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