The Cost of Overlooking Monthly Exclusion Checks

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On September 29, 2025, a home health company in Arizona, agreed to pay $20,000 to settle allegations of violating the Civil Monetary Penalties Law (CMPL). The Office of Inspector General (OIG) alleged that the home health company employed an excluded individual—someone prohibited from participating in any Federal health care program—as a home health aide. The individual’s services were allegedly billed to these programs, triggering the violation. While $20,000 may seem modest in comparison to larger…

Are You Aware of the MDS Validation Program?

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Hopefully, you (and your Minimum Data Set (MDS) Coordinator or Resident Nurse Assessment Coordinator (RNAC)) are aware of the importance of checking the Validation Reports after submitting MDS assessments. This has always been the expectation and best practice to find any errors in a timely manner, make corrections, and ensure that MDS submissions are accurate and accepted. If you are in the habit of checking your Validation Reports in the Internet Quality Improvement and Evaluation…

Strengthening Medical Director Roles in Skilled Nursing: A Timely Look Ahead

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Medical directors are central to the clinical integrity of skilled nursing facilities—but how involved are they, really? While federal regulations outline specific responsibilities, there’s growing concern that the roles of medical directors are inconsistently defined, poorly documented, or limited in practice. In response, the U.S. Department of Health and Human Services (HHS), through its Office of Evaluation and Inspections (OEI), has launched a federal review to assess how medical directors are engaged—and how that engagement…