13 unchanged sentences
Department of Justice stating that it was investigating to determine whether there had been a violation of the False Claims Act and/or the Anti-Kickback Statute with respect to the relationships between certain of our independently operated skilled nursing facilities and persons who serve or have served as medical directors, advisory board participants or other potential referral sources.
+Added: Additionally, we are aware of a claim filed by an individual related to this matter.
As a general matter, our independent operating entities have established and maintain policies and procedures to promote compliance with the False Claims Act, the Anti-Kickback Statute, and other applicable regulatory requirements.
12 unchanged sentences
authorities could also seek the suspension or exclusion of the provider or individual from participation in their programs.
−Removed: We believe that there has been, and will continue to be, an increase in governmental investigations of LTC providers, particularly in the area of Medicare/Medicaid false claims, as well as an increase in enforcement actions resulting from these investigations.
+Added: We believe that there has been, and will continue to be, an increase in governmental investigations of long-term care providers, particularly in the area of Medicare/Medicaid false claims, as well as an increase in enforcement actions resulting from these investigations.
Adverse determinations in legal proceedings or governmental investigations, whether currently asserted or arising in the future, could have a material adverse effect on our financial position, results of operations, and cash flows.
35 unchanged sentences
Medicare Revenue Recoupments — We and our independent operating subsidiaries are subject to regulatory reviews relating to the provision of Medicare services, billings and potential overpayments resulting from reviews conducted via RAC, Program Safeguard Contractors, and Medicaid Integrity Contractors (collectively referred to as Reviews).
−Removed: For several months during the COVID-19 pandemic, CMS suspended its Targeted Probe and Educate Program.
−Removed: Beginning in August 2020, CMS resumed Targeted Probe and Educate Program activity.
+Added: For several months during the COVID-19 pandemic, CMS suspended its Targeted Probe and Educate (TPE) Program.
+Added: Beginning in August 2020, CMS resumed TPE Program activity.
If an operation fails a Review and/or subsequent Reviews, the operation could then be subject to extended review or an extrapolation of the identified error rate to billings in the same time period.
We anticipate that these Reviews could increase in frequency in the future.
−Removed: As of March 31, 2023 and through the filing date of this report, 17 of our independent operating subsidiaries had Reviews scheduled, on appeal, or in a dispute resolution process.
+Added: As of June 30, 2023 and through the filing date of this report, 37 of our independent operating subsidiaries had Reviews scheduled, on appeal, or in a dispute resolution process.
+Added: CMS announced a new nationwide audit, the “SNF 5-Claim Probe & Educate Review”, in which the Medicare Administrative Contractors will review five claims from each SNF to check for compliance.
+Added: In implementing this SNF 5-Claim Probe & Educate Review, CMS acknowledged that the increase in observed improper payments from 2021 to 2022 may have arisen from a “misunderstanding” by SNFs about how to appropriately bill for claims of service after October 1, 2019.
+Added: All facilities that are not undergoing TPE reviews, or have not recently passed a TPE review, will be subject to the nationwide audit.
+Added: MACs will complete only one round of probe-and-educate for each SNF, rather than the three rounds that typically occur in the TPE Program.
+Added: Additionally, CMS’s education for each SNF will be individualized and based on observed claim review errors, with rationales for denial explained to the SNF on a claim-by-claim basis.
+Added: This program will apply only to claims submitted after October 1, 2019, and will exclude claims containing a COVID-19 diagnosis.
Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.