Latest news with #SNFs
Yahoo
29-04-2025
- Business
- Yahoo
CoreCare introduces Pre-Admit to assess skilled nursing referrals
AI-powered workflow platform CoreCare has launched Pre-Admit, a product that accelerates and improves the way Skilled Nursing Facilities (SNFs) process referrals. This solution can deliver assessments within one minute. Pre-Admit has been launched in collaboration with Creative Solutions in Healthcare, which has more than 160 SNFs. The new fully web and mobile-enabled solution aims to streamline the decision-making process for admissions teams. Creative Solutions in Healthcare CEO Gary Blake said: 'We've partnered with CoreCare for over five years, and we didn't adopt their AI because it's trendy. We did it because CoreCare's technology helps our teams work together to make smarter decisions. 'Pre-Admit is the next step in our partnership. It shows our staff what matters, breaks down silos, and helps us get to yes with more referrals - faster and with increased confidence.' Traditionally, clinical reviews could take upwards of 20 minutes, with nearly 67% of admissions proceeding without complete financial verification. This exposes providers to potential financial losses and recoveries. Pre-Admit addresses this issue by quickly identifying clinical and financial risks, allowing admissions teams to act swiftly, increase patient intake, and safeguard their financial margins. CoreCare co-founder and CEO Dennis Antonelos said: 'Pre-Admit redefines how SNFs evaluate and act on referrals. 'It's built to embed expert-level clinical and financial evaluations across every facility, team, and shift - regardless of who's on the floor or in the office. We're proud of our partnership with Creative Solutions in Healthcare, and proud of our team for strengthening CoreCare's platform, giving providers more functionality in one system.' Pre-Admit expands the functionality of CoreCare's Collaborative Revenue Management platform, which already includes products for admissions, reimbursement, and revenue cycle workflows. The platform aids in the optimisation of billing processes, tracking of compliance across PASRR and management of Medicaid applications. "CoreCare introduces Pre-Admit to assess skilled nursing referrals" was originally created and published by Hospital Management, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Sign in to access your portfolio
Yahoo
26-02-2025
- Business
- Yahoo
Massachusetts nursing homes, RegalCare, allegedly billed patients for unnecessary care
BOSTON (WWLP) – The United States Attorney's Office and the Massachusetts Attorney General's Office have filed a joint complaint against 19 skilled nursing facilities (SNF) in Massachusetts and Connecticut for alleged fraudulent billing. The complaint was filed on Tuesday under the federal and Massachusetts False Claims Act against these SNFs and their present and former management companies, RegalCare Management Group, LLC, and RegalCare Management 2.0. SNFs serve as inpatient facilities providing transitional care to patients following a hospital stay. Federal healthcare programs like Medicare or Medicaid reimburse providers for medically necessary services provided to patients. Mass. man charged in connection with $30 million healthcare fraud scheme This joint complaint alleged that between 2017 and 2023, RegalCare fraudulently submitted claims to Medicare and Medicaid under the direction of owner Eliyahu Mirlis and executive Hector Caraballo. The claims were allegedly submitted for medically unnecessary and unreasonable services to RegalCare's SNF patients. The documents also state that Stern Therapy Consultants, who works for RegalCare, allegedly aided the company as a co-conspirator. usa_v._regalcare_et_al_-_complaint_and_exhibits-1Download The scheme allegedly resulted in millions of dollars of damages to the Medicaid and Medicare programs as a result. RegalCare, at Mirlis' direction, was alleged to have caused Medicare to be billed for the highest level of skilled rehabilitation therapy services at these SNFs in Massachusetts and Connecticut, despite the patients not needing those services. Caraballo allegedly altered and amended records to ensure that patient records matched the billing. The United States further stated that Stern Therapy Consultants scheduled therapists to provide unnecessary services for RegalCare patients and that Stern managers would threaten therapists if they refused to comply with the scheme. 'I am proud of our team's partnership with the USAO in this case, which advances elder justice and safeguards crucial nursing home funds,' said Massachusetts Attorney General Andrea Joy Campbell. 'My office will continue to work aggressively to protect our elders and hold companies accountable that seek to harm them or violate our false claim laws.' The U.S. and Massachusetts governments filed the complaint in a lawsuit originally filed by a whistleblower under the qui am provisions of the False Claims Act, which allows a private citizen to sue on behalf of the United States or Mass. and share in any recovery. In Massachusetts, RegalCare has facilities in Amesbury, Danvers, Greenfield, Harwich, Holyoke, Lowell, Quincy, Saugus, Taunton and Worcester. WWLP-22News, an NBC affiliate, began broadcasting in March 1953 to provide local news, network, syndicated, and local programming to western Massachusetts. Watch the 22News Digital Edition weekdays at 4 p.m. on Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
