Inappropriate Payments to Skilled Nursing Facilities Cost Medicare More Than a Billion Dollars in 2009

Nursing homes are overcharging Medicare to the tune of $1.5 billion annually, a federal report asserts.

The report, titled “Inappropriate payments to skilled nursing facilities cost Medicare more than a billion dollars in 2009,” says that SNFS are upcoding bills to Medicare, either by claiming more services than were done or by giving incorrect treatment.

Under particular scrutiny are physical, occupational and speech therapy, as well as activities of daily living assistance.

A Centers for Medicare & Medicaid Services spokesman told the Wall Street Journal the agency recognizes the overbilling and that doing it “at the expense of taxpayers is unacceptable.” The report, dated Friday, was first reported Tuesday.

Other industry officials have said that nursing homes have upcoded Medicare claims to offset steep Medicaid cuts or losses, and that those days may be coming to an end.
The OIG has bequeathed the name “Operation Vacuum Cleaner” for its look at the issue, the Journal reported. The office has suggested, and CMS agreed with, the following recommendations:

• Increase and expand reviews of SNF claims
• Use of the agency's Fraud Prevention System to identify SNFs that are billing for higher paying RUGs
• Monitor compliance with new therapy assessments
• Change the current method for determining how much therapy is needed to ensure appropriate payments
• Improve the accuracy of MDS items
• Follow up on the SNFs that billed in error.
CMS concurred with all six recommendations.

Source:
OIG Slams SNFs for Overbilling

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