Nursing Homes Caught Billing For More Therapy Than Patients Require

According to a recent article from The New York Times, federal investigators have  reported that Medicare payments received by nursing homes far exceed the amount it costs them to provide care, manipulating the billing system in some instances by providing patients more therapy services than is necessary.

The inspector general of the Department of Health and Human Services issued a report disclosing that nursing homes often file claims for the highest, most costly level of therapy, disregarding what patients actually needed.

In the past several years, nursing homes have been reporting an increasing number of patients as requiring the highest level of therapy and giving the exact amount needed to qualify for high payments. “Skilled nursing facilities must provide therapy for 720 minutes or more during a seven-day assessment period to bill for ultrahigh therapy,” and more and more of them “provided exactly 720 minutes,” says the inspector general, Daniel R. Levinson.

Nursing homes are more frequently receiving Medicare payments for reasons that have nothing to do with the condition or qualities of patients, the report states. The inspector general referenced claims data as proof that some nursing homes had misused the system “to optimize revenues.” As an example, Mr. Levinson used a Medicare beneficiary who was given hospice care prior to and post nursing home stay, was given physical therapy five days per week for five weeks, “even though her medical records indicated that she asked that the therapy be discontinued.” He stated that the additional billings cost Medicare $1.1 billion between 2012 and 2013.

Andrew M. Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services did not disagree with the findings. He stated that the current payment system entices nursing homes to “provide as much therapy to a resident as that resident can tolerate.”

The inspector suggested that Sylvia M. Burwell, the secretary of health and human services, decrease Medicare payment rates for therapy in nursing homes. Although Mr. Slavitt agreed, he said that Congress would need to give the agency “additional statutory authority.”

Nonetheless, Mr. Slavitt said, Medicare will increase its efforts to prevent fraud and identify “suspicious billing behavior” by nursing homes.