Kelly Simonelli

Antipsychotic Drug Use in Nursing Homes: OIG Findings and What Providers Must Do

The inappropriate use of antipsychotic drugs in nursing homes has been a long-standing issue for the Office of Inspector General (OIG). Recent findings reinforce just how critical proper oversight and clinical decision-making are in protecting vulnerable residents. In a review of forty focused nursing home inspections completed by the Centers for Medicare & Medicaid Services (CMS), the OIG identified several troubling patterns. Key Findings from the OIG Review The report revealed residents with dementia were…

DOJ’s New Corporate Enforcement Policy: What It Means for Compliance and Healthcare Organizations

The U.S. Department of Justice (DOJ) has rolled out a new, unified Corporate Enforcement Policy (CEP) for all criminal cases. While that may sound like just another regulatory update, it signals a broader shift in how corporate misconduct is evaluated and ultimately resolved. For healthcare organizations and compliance leaders, this is more than just a compliance update. It represents another clear indication that expectations around compliance, transparency, and governance are continuing to advance. A More…

Understanding Case Mix Index (CMI) and Why Accurate Documentation Matters

The Case Mix Index (CMI) is a numerical value assigned to each resident based on their acuity level.  Simply put, the higher the acuity, the higher the CMI value. Because CMI directly influences reimbursement, it is essential that it accurately reflects the clinical complexity of the residents being served. Under the Patient Driven Payment Model (PDPM), residents are classified into case mix categories based on several factors, including clinical characteristics, resident assessments, resident diagnosis and…