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Study Says Nursing Homes Overbilled Feds by 1.5 Billion in Medicare Payments

A study released this week by the Department of Health & Human Services say that nursing homes overbilled Medicare by 1.5 billion in 2009. This comes at a time when the nursing home industry is lobbying Congress to avoid cuts in Medicare payments.

The study says that claims billed in 2009 were “upcoded,” which means that Medicare was billed for services that were more intensive than the patient needed, or were billed for high amounts of therapy that weren’t actually provided. Many of the claims were for intensive physical or occupational therapy.

Nursing home officials disagree with these reports, claiming that “bureaucrats” don’t really know or understand what individual patients need. Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living, said in a press release that nursing homes provide life-changing therapies for thousands of patients that shouldn’t be disqualified by this report. Parkinson says, “Three years later, the government steps in and second guesses those decisions, without the benefit of the patient’s views or even acknowledging what a doctor prescribes. It’s easier to say ‘no’ to a file than a person, but to do so discounts the necessary care we deliver.”

The nation’s nursing homes are facing Medicare cuts in lieu of cuts to defense or entitlement spending. Greg Crist, the American Health Care Association’s Vice President of Public Affairs, said his industry is already facing an uphill battle to prevent cuts and that it’s too soon to tell whether the federal report will hurt its efforts.

Meanwhile, feds say nursing homes affect patient care when they do not report their information accurately, and there needs to be more fundamental change in place to prevent fraud and overpayment for services not needed or not provided.
Parkinson agrees with all actions to stop fraud and will continue to do so. However, he says this report implies misconduct during treatment, and that is wrong.