Articles Tagged With: Medicare
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Supreme Court Ruling Changes View of Wrongful Intent
A Supreme Court ruling is changing how a defendant’s knowledge of wrongdoing and intent to commit fraud is viewed in civil cases. The ruling has significant implications for healthcare cases in which the False Claims Act is involved.
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Compliance Requirements Continue to Change, Need Close Attention
Healthcare compliance is a never-ending challenge, and the expectations change constantly. Staying abreast of new developments is essential. Some of the latest involve the False Claims Act, Medicare risk adjustments, and HIPAA enforcement.
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Health System’s Case Managers Shorten Length of Stay for Complex Patients
Placing case managers in acute care and ambulatory settings to focus on transitions of complex patients could help shorten length of stay.
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Navigating Elder Care and Long-Term Care
Elder care in the United States is increasingly a “major source of moral distress in the hospital case management and social work world,” according to Lisa Bednarz, LCSW, CMAC, ACM-SW, ASW-G, regional director of case management for Robert Wood Johnson Barnabas Health.
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More Efficient Social Care Programs Could Improve Screening and Tailor Solutions
Researchers are finding that Accountable Health Communities need greater flexibility in activities geared toward improving patients’ health-related social risks. The Centers for Medicare & Medicaid Services adopted quality metrics for health systems, requiring them to screen for health-related social risks. The authors of a new study found that the model does not allow for the flexibility needed to ensure hospitals sustain the adoption of AHC activities.
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Caring for COPD Patients During Winter
Navigating the care of patients who are living with chronic conditions already is challenging, but it takes an extra layer of thoughtfulness for a case manager to also consider the climate and season when making plans and facilitating decisions for patients with COPD.
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Large Medicare Data Study Shows Big Benefits with Primary Care Follow-Up
New research shows Medicare patients who are hospitalized with a condition that could require emergency general surgery are far less likely to be readmitted if they receive follow-up care with a primary care provider within 30 days of discharge.
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President’s Group on Patient Safety Publishes Recommendations
The President’s Council of Advisors on Science and Technology recently released its findings and recommendations on patient safety in a report that outlines how “patient safety is an urgent national public health issue.”
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Supreme Court Ruling Helps with Meritless False Claims Act Lawsuits
The U.S. Supreme Court issued an important ruling that will help healthcare organizations and practitioners gain relief from meritless whistleblower lawsuits under the False Claims Act.
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Know How False Claims Act Works to Prevent Violations
Understanding the ins and outs of the False Claims Act can prevent violations and improve the outcome if the government or a whistleblower does allege fraud and abuse. False Claims Act investigations are almost impossible to avoid for large companies, so risk managers must thoroughly understand the law.