For-profit nursing home companies led by Kindred Healthcare Inc. and Sun Healthcare Group Inc. are likelier than non-profit counterparts to overbill Medicare for the costliest services, according to a U.S. government report.Medicare should investigate instances in which companies keep patients longer, charge more for care and classify clients for more extensive and costly services than needed, the study released today by the inspector general found.
The findings, based on audits of nursing-home billings from 2006 to 2008, “raise concerns about the potentially inappropriate use of higher-paying” billing codes, said the report by the Health and Human Services Department’s Office of Inspector General. It recommends that Medicare, the U.S. health insurance program for the elderly and disabled, consider changing its payment method for nursing home services.
The program covers as much as 100 days of nursing-home services for beneficiaries who require skilled care or rehabilitation following a hospitalization of at least three consecutive days. Care can be provided in a hospital or free- standing facility.
Medicare plans to target an undisclosed list of nursing homes with “questionable” billing practices, according to the report. The program specifically is examining “special-nursing facilities” for patients recovering from an injury or who are disabled.
California Representative Pete Stark, the ranking Democrat on the House Ways and Means Health Subcommittee, has been critical of the reimbursements that special nursing facilities get from Medicare. Medicare pays too much for the therapy services that the companies were billing more for, and too little for other services, his Stark’s spokesman, Brian Cook, said in an e-mail.
Stark unsuccessfully attempted to change the payments to nursing facilities in the health-care law signed by President Barack Obama in March.
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For-Profit Nursing Homes Overbilling U.S. Government
I would imagine this is happening everywhere. I hope Medicare is investigating this as a national problem.
ReplyDeleteThis is proof positive that Medicare services don't have to be cut -- cut the fraud and there ill be plenty of funding.
ReplyDeleteThis is another systemic problem with a long history and roots that can be traced to our country's leadership.
ReplyDeleteLong before 2006, nursing home reform advocate Ila Swan circulated information, including GAO reports, about this problem with Kindred and most of the other big nursing home chains.
I recall some of the details Ila provided, including the fact that one of these nursing home chains was owned by Bill Frist, a then prominent U.S. senator.
Until Ila suffered a stroke, she was one of the most ardent and effective reform advocates I knew. Since then, I have connected with Carole Herman and her organization F.A.T.E. Anyone wanting to know more about nursing home related problems should consider contacting Carole or Violette King, another strong nursing home reform advocate with whom I once had some contact.
overbilling is fraud and its not an error if we did this we would have criminal charges brought nursing facilities contribute mega money to legislators thats why they get away with criminal behavior they buy their way out folks and they want us as a product in their facilities generation after generation look in the mirror we the people have $ on our foreheads ~ do you see it?
ReplyDeleteOverbilling the Us govt means overbilling the taxpayers!
ReplyDeleteThank you, TVFields
ReplyDeleteIt's not just nursing homes, it's doctors holding the elderly and disabled hostage .......it's Medicare not doing it's job. Just recently we got a bill for a cast on my husband's leg .........a cast that was never put on .......so I called Medicare and they told me it was my responsibility to got after the doctor. Three hours later I convinced Medicare it was theirs and then they bought that the doctor made a mistake ,,,,,,,, we the doctors office called me, the woman told me she was not in charge of billing and many times the husband altered bills ......
ReplyDeletea hundred dollars of fraud on a 1000 patient visits is an extra 100,000 a year and extra thousand dollars is a million a year ......
Doctors see more than a 1000 patient visits a year ........
This is no shock. The crooks know they can get away with stealing from taxpayers.
ReplyDelete