Nursing homes throughout the United States billed Medicare for more therapy than some patients needed, actions that ultimately led to overpayments surpassing a billion dollars nationwide, the New York Times reported.
The inspector general for the Department of Health and Human Services released the report showing that some nursing homes consistently filed claims for the most expensive forms of therapy despite the patients’ needs at the time they received the treatments. This practice cost a total of $1.1 billion in excess payments from Medicare, according to the government watchdog.
The Times reports:
Medicare payments to nursing homes are increasing for reasons unrelated to the condition or characteristics of patients, the report said.
The inspector general cited claims data as evidence that some nursing homes had exploited the system "to optimize revenues." For example, Mr. Levinson said, a Medicare beneficiary who received hospice care before and after her nursing home stay received physical therapy five days a week for five weeks, "even though her medical records indicated that she asked that the therapy be discontinued." He said the extra billings cost Medicare $1.1 billion in 2012-13.
Medicare classifies nursing home residents into one of 66 groups depending on the patient’s needs. More than one-third of the groups are for patients who require physical, occupational or speech therapy. Medicare pays more for patients who require the most therapy.
The acting administrator of the Centers for Medicare and Medicaid Services, Andrew M. Slavitt, did not dispute the findings. He said the current payment system created an incentive for nursing homes to "provide as much therapy to a resident as that resident can tolerate."