HHS’ OIG: Nursing Homes Bill Medicare for More Therapy Than Needed
Nursing homes receive Medicare reimbursements that are higher than the cost of care they provide, according to an HHS Office of Inspector General report released Wednesday, the New York Times reports.
The report said that some nursing homes classified an increasing number of patients as needing the highest levels of therapy and then they provided exactly that amount of therapy to "optimize revenues," regardless of a patient's condition or need. Such extra billings amounted to $1.1 billion in Medicare costs in 2012-2013.
HHS Inspector General Daniel Levinson gave an example of a Medicare beneficiary in hospice care who was given physical therapy "five days a week for five weeks" despite the beneficiary asking for such services to be stopped.
Levinson said HHS Secretary Sylvia Mathews Burwell should consider reducing Medicare payments for therapy delivered within nursing homes.
Acting CMS Administrator Andy Slavitt agreed, saying that Congress would need to give CMS "additional statutory authority" to do so. He added that Medicare will bolster fraud detection efforts against nursing homes.
The American Health Care Association, which lobbies Congress on behalf of nursing homes, said it supports Medicare moving "away from paying providers based solely on their volume of services." The industry encourages a lump sum payment for a patient's entire stay.
AHCA spokesperson Greg Crist added that while Medicare reimburses nursing homes for more than their costs of coverage, two-thirds of nursing home patients are covered by Medicaid, which often does not reimburse for the full costs of a patient's stay (Pear, New York Times, 9/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.