For nursing homes, complying with Medicare rules is simple: Focus on quality of care.
That's according to HHS' inspector general's office, which last week released the final Medicare compliance guidelines for nursing homes at the annual meeting of the American Association of Homes and Services for the Aging in Washington.
"The (inspector general's office) believes that a nursing facility's compliance policies should start with a statement that affirms the facility's commitment to providing the care and services necessary to attain or maintain the residents' highest practicable physical, mental and psychosocial well-being," the guidelines say.
Federal prosecutors have already wrested many monetary settlements from nursing homes, arguing that government health programs such as Medicare should pay only for quality care. Submitting claims without providing quality care constitutes Medicare fraud, they said (Feb. 22, 1999, p. 8).
Signs of poor quality include inappropriate or insufficient treatment, inadequate staffing levels and failure to report incidents of mistreatment, neglect or abuse of residents to the facility's administrator.
Len Fishman, president of the AAHSA, which represents more than 5,000 not-for-profit long-term-care providers, told his members that "even the most basic (compliance) plan is good business."
However, smaller facilities may struggle with developing a more-comprehensive plan, as outlined in the guidelines, he said. "We wish the inspector general had taken advantage of more existing research on quality outcomes without asking facilities to reinvent the wheel," Fishman said.
George McLain, an AAHSA member and executive director of Oaks Foundation in Sebring, Ohio, called the guidelines "the stupidest thing I've ever heard. It's going to cost hundreds of thousands of dollars to write down what we're already doing." Oaks Foundation owns three nursing homes.
But Lewis Morris, HHS' assistant inspector general, said compliance doesn't need to cost a fortune.
"At a minimum, address the concerns identified in the annual surveys (of your facilities)," Morris told AAHSA members. "The best compliance dollars are invested in making sure people know the rules."
The guidance was published in the Federal Register March 16.
To date, the inspector general has released compliance guidance for hospitals, clinical laboratories, home health agencies, third-party medical billing companies, durable medical equipment suppliers, hospices and Medicare managed-care plans. All compliance guidelines are available at the inspector general's World Wide Web site, www.hhs.gov/oig.