Photo of Lourdes Martinez

Lourdes M. Martinez is a partner in the Governmental Practice in the firm's New York office.

On November 17, 2023, the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”).[1] The Final Rule also includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment purposes for all Medicare institutional providers and suppliers.Continue Reading CMS Issues a Final Rule Requiring Nursing Facilities and Other Providers and Suppliers to Disclose Additional Ownership Information

On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities.[1] If the proposed rule is finalized, CMS estimates that approximately 75% of all nursing homes would have to “strengthen staffing in their facilities” in order to meet the new requirements.[2]Continue Reading Long Term Care Facilities Face Mandatory Minimum Staffing Requirements

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.Continue Reading New York Medicaid Providers Now Have Two Pathways to Self-Disclose Overpayments to the Office of the Medicaid Inspector General

On June 30, 2023, the New York State Department of Health (DOH) issued a notice to nursing home operators and administrators announcing that it will begin conducting assessments on July 10, 2023 of nursing homes’ compliance with the State’s minimum staffing requirements. Nursing homes that fail to adhere to the three requirements outlined in the minimum staffing standards in any quarterly period face civil penalties of up to $2,000 per day that they are out of compliance.Continue Reading NY Nursing Home Minimum Staffing Assessments Set to Begin

With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid Services (CMS) has instructed each of its Medicare Administrative Contractors (MACs) that review SNF Medicare claims to initiate a five-claim probe and educate medical review for each SNF in the MAC’s jurisdiction.Continue Reading CMS Takes Steps to Lower SNF Medicare Payment Error Rates

On February 15, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require nursing homes enrolled in Medicare and Medicaid to disclose new information about their ownership and management structures. If finalized, the rule would require nursing homes to disclose any ties to private equity companies or real estate investment trusts (REITs) (defined below), as well as the names and information of individuals and entities that provide certain administrative, management or consulting services.Continue Reading CMS Issues Proposed Rule Requiring Nursing Homes to Disclose Additional Ownership Information, Including Ties to Private Equity and REITS

Regulatory enforcement and large litigation relating to the use of third party trackers on companies’ websites and applications have been on the rise. Tracking often occurs without the companies’ knowledge or consent. Third party tracking on hospital and provider websites has specifically garnered notable media attention. Recently, there has been significant activity by the Federal Trade Commission (“FTC”) under the Health Breach Notification Rule for unauthorized sharing of personal information. It has begun to penalize and impose steep corrective actions, including long-impacting future restrictions, for such violations.Continue Reading Web Tracking Creates a Web of Data Privacy Risks

As 2023 begins, the nursing home industry faces unprecedented challenges on multiple fronts. While facilities struggle with a labor crisis, chronic underfunding, high inflation and a combined resurgence of COVID-19 and the flu, the government is ramping up efforts to hold them to even higher operational and regulatory standards. The Biden administration, as well as many state governments, are pushing reforms that will make it much more challenging to operate a compliant and financially viable facility, including minimum staffing levels, increased health and safety surveys, more significant financial penalties, and greater scrutiny of ownership, finances and related party arrangements. In addition, the government is bringing civil False Claims Act cases, and in some cases filing criminal health care fraud charges, against facilities that provide substandard care. Some states are also seeking to impose monitors and enjoin nursing home operations at underperforming facilities.Continue Reading Nursing Homes Brace for Reforms and Heightened Government Scrutiny

Overall, healthcare professionals are 10-15% more likely to develop substance abuse issues than the general population.[1] As addiction to prescription medication has reached nation-wide epidemic proportions, it has become a major driver of drug diversion. Drug diversion occurs when prescription medicines are obtained or used illegally. Healthcare practitioners and facilities are the gatekeepers tasked with safeguarding prescription controlled substances. The failure of a facility to effectively prevent drug diversion leads to substandard care, the denial of essential pain medication or therapy, risk of infection, and even death. Continue Reading Don’t Let Drugs Bring You Down: The Importance of an Effective Drug Diversion Program

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program. These changes are consistent with the Federal government’s goal of improving safety and quality of care for the nation’s roughly 1.5 million nursing home residents.Continue Reading Long Term Care Update: CMS Revises Criteria for its Special Focus Facility Initiative

On September 21, 2022, the Select Subcommittee on the Coronavirus Crisis held public hearings and issued a report assessing the performance of large, for-profit nursing home chains during the early phase of the Coronavirus pandemic. The Subcommittee’s ongoing investigation began in June 2020, and focused on five for-profit nursing home chains that collectively operated over 850 skilled nursing facilities, each of which had significant outbreaks across their facilities. The Subcommittee’s key findings paint an extremely negative picture of for-profit facilities, and include the following allegations:Continue Reading U.S. Congressional Committee Takes Aim at For-Profit Nursing Homes