Determining "Medical Necessity" in an Government Review of Skilled Nursing Facility Records

Session Year: 
2015
authors: 
Judy Wilhide Brandt, RN

As a legal expert for the Department of Justice and other government agencies in skilled nursing facility (SNF) fraud cases, the presenter will explain the government's point of view, discuss how a determination is made, and what the medical director's responsibility is in these government probes. The session will describe different types of government probes, explain the False Claims Act and how it's used against SNFs, review recent cases and outcomes, and provide steps to take when faced with a government probe.

cmd: 
1 Management
cme: 
1