Compliance News Roundup: Skilled Nursing Facility Three-Day Inpatient

1. Genetic Testing Company Agrees to Pay $1.99 Million to Resolve Allegations of False Claims to Medicare for Medically Unnecessary Tests – “The Department of Justice is committed to ensuring that Medicare reimburses costs for laboratory testing that are reasonable and necessary for the individual patient,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Medically unnecessary and unproven testing increases costs for federal health care programs.” Get the full scoop >>

2. Laurel-based Physicians Group and Neurologist Agree to Pay Almost One Million Dollars to Resolve False Claims Act Allegations – “Jefferson Medical Associates, a now dissolved, multi-specialty medical practice group in Laurel, and Dr. Aremmia Tanious, have agreed to pay the United States $817,635.06 to resolve claims under the False Claims Act arising from Medicare overpayments to Jefferson Medical Associates and Dr. Tanious.” Get the full scoop >>

3. Deeper Than the Headlines: Skilled Nursing Facility Three-Day Inpatient – For a Medicare patient to be eligible for coverage of post-hospital extended care services, they must be an inpatient in a hospital for not less than 3 consecutive calendar days before being discharged from the hospital. Most compliance professionals working with skilled nursing facilities (SNF) know this as the 3-day rule. Well, the OIG’s most recent report took a hard look at this 3-day rule and determined that CMS improperly paid over $84 Million for SNF services that did not meet the 3-day rule during Calendar Years (CYs) 2013 through 2015. Get the full scoop >>