In a report recently issued by the Office of Inspector General, the federal government found that nursing homes overcharged Medicare $1.5 Billion in 2009 alone. By reviewing nursing facility claims in 2009, the federal government found that nursing homes billed 25% of all claims in error, resulting in $1.5 billion in inappropriate Medicare payments. Nursing homes use a tool called the Minimum Data Set to assess Medicare recipients’ needs. Based on this assessment, each resident is categorized into a different payment rate. The majority of incorrect claims were “upcoded” payment rates. 20% of claims billed by nursing homes had higher payment rates than were appropriate. Nursing home commonly billed for high-ticket services such as therapy. For nearly 60% of the upcoded claims, nursing homes reported providing more therapy than was indicated in the medical record. Click here to review the OIG’s report, “Inappropriate Payments to Skilled Nursing Facility Cost Medicare More Than a Billion Dollars in 2009”.
