Literature Review

OIG’s Audit of Nursing Home Workers in Louisiana Finds Flaws in Background Check ProcessSkilled Nursing NewsDecember 6, 2023A federally commissioned report released Wednesday found that nursing homes in Louisiana failed to complete background checks on a portion of their non-licensed employees. In conducting the audit to examine whether Louisiana nursing homes complied with federal requirements for backgrounds checks, the Office of Inspector General chose a sample of 9 Louisiana nursing homes out of a total of 276 licensed facilities in the state, basing its sample size on a variety of risk factors and on the need to select nursing homes in urban and rural settings, the agency said. ... The OIG report states. “Although Federal requirements do not specify the methods or types of information that should be considered for a background check to be regarded as having been satisfactorily completed, we identified potential limitations in the nursing homes’ background check searches and adjudication methods for 49 of the 209 non-licensed employees we reviewed.” In response to OIG’s findings and recommendations, Louisiana has agreed to update its standard survey process to ensure routine monitoring of nursing homes’ compliance with background check requirements by reviewing a sample of 5% of current non-licensed staff and by directing nursing homes to conduct self-audits of current personnel files. ... Among the findings, some disturbing practices emerged. Of the 9 nursing homes closely investigated, six nursing homes, and some of the staffing companies with which they contracted, had employee background check searches conducted that did not include a statewide search of State police records.

The Medicare Gold Rush Is Slowing DownWall Street JournalDecember 6, 2023The popularity of private Medicare plans has been a huge driver of profits for insurance companies in recent years. There are signs the gold rush isn’t quite what it once was. ... The most immediate red flag came from the industry leader, UnitedHealth. During an investor day last week, it predicted its Medicare Advantage enrollment would grow by 450,000 to 550,000 seniors in 2024. That translates to around 5% growth next year, a significant slowdown from the 11% it grew so far this year, according to TD Cowen analyst Gary Taylor. As UnitedHealth executives were presenting in New York, The Wall Street Journal reported that the second-largest Medicare plan provider, Humana, was in merger talks with Cigna. While Cigna’s interest in Humana surely attests to insurers’ continued desire to expand into the Medicare market, some investors took it as a sign that Humana isn’t so sure about the strength of the business going forward. 

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023Healthcare DiveDecember 4, 2023The HHS’ Office of the Inspector General is expected to recover more than $3.44 billion in fiscal year 2023 as a result of investigations into fraud and misspent funds in Medicare, Medicaid and other government health programs, according to the agency’s latest report.

Hospices Seek Special Focus CONs to Reach Underserved PopulationsHospice NewsDecember 1, 2023Some states with certificate of need regulations have special focus policies that allow hospice providers to expand services among underserved communities. But navigating these CON processes can be a challenge. ... A difficulty in seeking these types of special focus CONs is proving an unmet need among specific populations, according to André Lee, co-founder and administrator of Nashville-based Heart’n Soul Hospice.

MedPAC Meeting 12/7-8/23.Register for the Thursday, December 7 afternoon session (1:30PM to 5:00PM) by clicking here. Topics covered include: Assessing payment adequacy and updating payments: Hospice services.Notable Mentions: Kim Neuman.