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December 2022 | Issue 23
Solutions Spotlight
The Pandemic
Aftershock: Senior
Living Litigation in the Wake of COVID-19

Earlier this year, the New York Times published an article1 detailing a
$53 million settlement agreed to between an east coast state and
the families of the residents who lived in two state-run senior living
facilities during the initial COVID-19 outbreak in spring 2020. At the
time, the settlement was the first of its kind nationwide for COVID-19
litigation. What made the settlement so high, besides a large
number of claimants? The issue of gross negligence. In this case,
staff were allegedly told not to wear masks prior to April 2020 to
avoid scaring residents, and were banned from taking masks out of
facility supplies. Plaintiffs alleged COVID-19 positive residents were
congregating with healthy residents without protective equipment.
While the settlement may have been the first of its kind, there are
similar lawsuits pending nationwide against private and public
nursing homes. Plaintiff’s lawyers are now using the size and scope
of the settlement as an outline for structuring future cases and
multi-party settlements.
The State of Clinical Reimbursement

As a SNF provider, you are constantly forced to take on new and evolving reimbursement challenges. Today that means facing obstacles which include PDPM rate adjustments, Managed Care growth, turnover and resource strains that directly impact reimbursement. With the industry changing so rapidly, understanding the trends within clinical reimbursement is more critical now than ever.

Download this report to get the perspective of nearly 500 industry professionals, who shared their top clinical reimbursement concerns, trends and offered insights into the strategies they plan to pursue moving forward.
Special Savings from Value First!

Germ free is the way to be - save on COVID related costs!

In 2014, CMS initiated a program to review clinical
documentation, combining a sample of claims with
education, to reduce errors in the claim’s submission process. They called this medical review strategy Probe and Educate. Believing the results to be successful, CMS expanded into all MAC jurisdictions, and refined their data mining and analysis process to identify potential Medicare fraud and improper payments. The focus shifted to claims that carried the greatest risk to the Medicare fund, and/or providers who had the
highest claim error rates and irregular billing practices as compared to their peers. As such, TPE claim selection is provider specific.
The Takeaway from the Recently Enacted Assembly Bill A7363A

The hits just keep on coming. As if The Consumer Financial Protection Bureau (“CFPB”) and the Centers for Medicare & Medicaid Services’ (“CMS”) joint “Notification Letter” threatening every SNF in the United States with federal and state enforcement actions wasn’t enough, New York State has now enacted Assembly Bill A7363A, also known as the “No Lien Law”.