Nursing Homes Overbilling Medicare

According to the Wall Street Journal, nursing homes are overbilling Medicare $1.5 billion dollars annually. A majority of nursing home residents are Medicare recipients, making Medicare a key payor for nursing homes throughout the United States. When residents are admitted to nursing homes, the nursing home is required to prepare a report known as a Minimum Data Set (MDS), detailing the type of care to be rendered to the resident and the degree or intensity of care, which is also referred to as the acuity. The amount of Medicare’s reimbursement to a nursing home is based on the acuity level. The greater the acuity, the larger the reimbursement. Increased care rendered to residents in nursing homes includes things such as speech therapy, physical therapy and occupational therapy.

The recent study by the Government, as reported in the Wall Street Journal, revealed that some nursing homes have been guilty of what is known as “upcoding,” a process in which they inflate their bill to Medicare by claiming that more intensive services were provided than were actually performed. For example, a facility may claim that physical therapy was rendered to a resident regularly when, in fact, little or no therapy was performed. In other cases, the study determined that nursing homes were providing inappropriate or unnecessary care for the sole purpose of inflating their bills to Medicare and receiving greater reimbursements.

Ironically, while nursing homes have been overbilling Medicare to the tune of $1.5 billion dollars annually, their lobbyists are asking Congress to enact a bill, HR 5, which would limit the recovery by a victim who has been abused or neglected in a nursing home. While nursing homes are defrauding the Government (and taxpayers), they are asking the Government to pass laws that would shield them from liability for negligently injuring residents. Keep in mind that many of these residents are part of the so-called “great generation,” comprised of men and women who fought for our country in World War II and other wars, built factories that provided jobs for thousands of citizens, and were tax-paying citizens themselves.

Suthers & Harper, which practices throughout the States of Georgia and South Carolina, regularly represents victims who have been abused or neglected and their families in cases against nursing homes and assisted living facilities. For more information, see the page entitled “Nursing Home Resource Center” at the website of Suthers & Harper,

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