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

摘要

SNFs provide skilled nursing care, rehabilitation services, and other services to Medicare beneficiaries who meet certain conditions. In fiscal year (FY) 2012, Medicare paid $32.2 billion for SNF services. The Office of Inspector General (OIG) has identified a number of problems with SNF billing. Notably, OIG found that 26 percent of claims submitted by SNFs in FY 2002 were not supported by the medical record, representing $542 million in potential overpayments. Recent OIG investigations have also found problems with SNF billing. For example, one SNF reached a settlement agreement on allegations of fraudulent billing for medically unnecessary therapy. Further, the Medicare Payment Advisory Commission (MedPAC) has raised concerns about SNFs improperly billing for therapy to obtain additional Medicare payments. Specifically, MedPAC noted that the payment system encourages SNFs to furnish therapy, even when it is of little or no benefit.This study is part of a larger body of work about SNF payments and quality of care. The first study found that from 2006 to 2008, SNFs increasingly billed for higher paying categories, even though beneficiary characteristics remained largely unchanged. Another study will assess the extent to which SNFs met certain Federal requirements regarding the quality of care provided to beneficiaries.