Health Law News From Arnold & Porter

Health Law News From Arnold & Porter

November 28, 2012
1 min read

BLOG: Inappropriate payments to skilled nursing facilities cost Medicare more than $1 billion

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From international law firm Arnold & Porter LLP comes a timely column that provides views on current regulatory and legislative topics that weigh on the minds of today’s physicians and health care executives.

A cornerstone of the care network for an aging population, skilled nursing facilities (SNFs) provide a wide range of skilled nursing and rehabilitation services to Medicare beneficiaries who meet certain conditions. In fiscal year 2012 alone, Medicare paid $32.2 billion for SNF services. However, a recent report from the U.S. Department of Health & Human Services Office of Inspector General (OIG) identified serious and ongoing concerns with billing practices for SNF services.

Ted Lotchin

Based on a review of almost 500 claims submitted in 2009, the OIG determined that SNFs billed 25% of claims in error, resulting in $1.5 billion in inappropriate Medicare payments. The OIG also determined that SNFs misreported information used to calculate Medicare payment rates in 47% of all claims. In light of these findings, the agency recommended that the Centers for Medicare and Medicaid Services instruct its contractors to conduct more medical reviews of SNF claims and use its fraud prevention system to identify SNFs that are billing for beneficiary stays with a higher reimbursement rate.

This report is the most recent in a series of studies evaluating Medicare payments for SNF services. The full text, along with the previous OIG reports, is available here through the agency’s website.

Ted Lotchin, JD, MPH, can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-5250; email: