Kelly Simonelli

Launch of Whistleblower Pilot Program Should Prompt Review of Compliance Program

Many, if not most, healthcare provider compliance programs identify overpayment from Federal Payers – particularly Medicare and Medicaid – as a key risk. Whistleblowers frequently initiate government scrutiny related to Federal payors. As a result, many compliance programs focus on the Federal piece of their payor mix. Providers that do not enroll with Federal payors or for whom Federal payors are a small portion of their payer mix may have chosen to commit fewer resources…

The Importance of Reviewing the Open Payment Database

Does your organization have an annual process to review the Open PaymentTM Database? The Open PaymentTM Database was created to promote transparency and accountability in the healthcare system and is managed by the Centers for Medicare & Medicaid Services (CMS). The database houses physician payments reported by Reported Entities such as drug and medical companies. These payments are reported annually and are broken down by “Nature of Payments” including food and drink, education, and consulting…

Federal Nursing Home Staffing Mandate Faces 20 State Lawsuit

The federal nursing home staffing mandate has been the center of conversation in the aging services space since it was debuted and took effect in early 2024. But, the fight against the regulation is starting to heat up. On Wednesday, October 10, 2024, twenty state attorney generals filed suit against the Centers for Medicare & Medicaid Services (CMS) to have this mandate overruled. The final ruling issued by CMS is available to read in the…