Los Angeles, California — The largest publicly operated health plan in the country is openly working to divert patients away from skilled nursing facilities, and it’s using better data and care management tools, not just slow prior authorization, to do it. That message came through clearly during a recent AHIP webinar featuring leaders from L.A. Care Health Plan, the nonprofit insurer that covers about a quarter of Los Angeles County residents. According to industry reports on the session, L.A. Care has built near real-time visibility into hospitalizations, discharges and risk scores, and it’s pushing that information to care teams while…
Author: Ahuva S
Richmond, Virginia — Virginia just took a closer look at its nursing home industry — and the order came straight from the governor’s pen. Gov. Abigail Spanberger signed a bill into law that requires the state’s Joint Commission on Healthcare to study how nursing homes operate, how they spend public money, and how well they actually care for residents, according to industry reports. The measure was driven by Del. Delores McQuinn, a Henrico Democrat whose district includes a facility federal regulators flagged as Virginia’s worst-performing nursing home. “The expectation was that if you owned the nursing home, that you were…
Washington, District of Columbia — More than half of Medicare fee-for-service beneficiaries are now aligned with an accountable care organization, and a former top federal innovation official says nursing homes should be moving fast to get inside that system before the next wave of payment models locks in. Purva Rawal, who recently stepped down as chief strategy officer for the Center for Medicare and Medicaid Innovation, told industry reports that ACOs have become the strongest mechanism the agency has for managing total costs while still improving outcomes — and that skilled nursing operators stand to gain by aligning early. Her…
Indianapolis, Indiana — Majestic Care says a broad certification push is starting to pay off inside its nursing homes, with company leaders pointing to stronger recruitment, better quality metrics and improved star performance across part of the portfolio. According to industry reports, Majestic Care leaders said certifications have become a practical hiring tool at a time when skilled nursing operators still face a tight labor market. Stephanie Fischer, the company’s senior director of RAI, said job candidates often ask whether the company will pay for certifications. Under Majestic’s organizational membership structure, staff can access those programs across the company, she…
Altadena, California — A skilled nursing facility that cared for elderly and disabled residents near the Pasadena-Altadena border for more than five decades is now suing Southern California Edison, alleging the utility’s electrical equipment ignited the Eaton Fire and destroyed the building. Two Palms Care Center filed the lawsuit May 6 in Los Angeles County Superior Court against SCE and its parent, Edison International. The complaint says the utility didn’t de-energize transmission lines on the evening of January 7, 2025, even though wind conditions exceeded SCE’s own shutoff thresholds and the National Weather Service had issued its highest-level warning, according…
Washington, D.C. — A federal rule that ends decades of fax-and-mail paperwork in healthcare claims is about to take effect, and skilled nursing operators are now on a two-year clock to replace one of the industry’s most stubborn pieces of office equipment. The Centers for Medicare and Medicaid Services finalized its claims attachments rule earlier this year, and the policy goes live on May 26, 2026 — this Tuesday. Covered providers, including nursing homes that bill Medicare and Medicaid, will have until May 26, 2028, to fully comply. The rule — formally titled the Administrative Simplification; Adoption of Standards for…
Las Cruces, New Mexico — A grand jury in Doña Ana County has indicted a woman accused of working as a nurse at four New Mexico care facilities without ever holding a license. The charges run 34 counts deep, and if she’s convicted on all of them, she could face up to 100 years in prison. The defendant, Margarita Gonzalez, faces charges that include identity theft, nursing without a license, abuse of a resident, distribution of controlled substances to a minor, and fraud topping $25,000. The indictment came after an investigation by New Mexico’s Medicaid Fraud and Elder Abuse Bureau,…
Hunt Valley, Maryland — Omega Healthcare Investors, one of skilled nursing’s biggest landlords, is about to look very different at the top. The company announced Thursday that longtime CEO Taylor Pickett will retire on October 1, with current President Matthew Gourmand stepping into the chief executive role. The succession was disclosed alongside a second major change: CFO Bob Stephenson plans to retire on August 1, with Chief Accounting Officer Neal Ballew taking over the finance job. For nursing home operators who lease buildings from Omega, the announcement marks the end of an era — and the start of one that’s…
Washington, D.C. — Nursing home advocates are pleading with the federal government to slow down on its sweeping new fraud crackdown, warning the plan could pile fresh paperwork on operators already drowning in regulation. The Centers for Medicare and Medicaid Services rolled out its Comprehensive Regulations to Uncover Suspicious Healthcare program — better known by its blunt acronym, CRUSH — in late February. The agency wants tighter screening for providers, artificial intelligence to flag suspicious claims, and shorter deadlines for filing them. After the public comment period closed on March 30, two of the largest advocacy groups in long-term care…
Pittsburgh, Pennsylvania — The trustee unwinding the bankrupt remains of one of the East Coast’s most controversial nursing home networks is now accusing its top executives of running the chain like a personal piggy bank. Robert Bernstein, the court-appointed trustee overseeing the liquidation of 22 affiliated nursing home companies tied to South Hills Operations and Comprehensive Healthcare Management Services (CHMS), filed an adversary complaint Thursday in the US Bankruptcy Court for Western Pennsylvania. The lawsuit names Ephram “Mordy” Lahasky, Samuel Halper, David Gast and Joshua Farkovits, along with a long list of affiliated management, holding and property entities, plus 50…
