OIG: Nursing homes are gaming Medicare

Share this article:
HHS Inspector General Donald Levinson
HHS Inspector General Donald Levinson

Nursing homes attempting to maximize payments often upcode Medicare residents and keep them longer than necessary. And for-profit providers are the worst offenders. That's the message in a scathing new report from the inspector general's office of the Department of Health and Human Services.

In a review that spanned 2006 through 2008, investigators found that the percentage of residents placed in the highest RUG categories jumped from 17% to 28%. About one-third of the residents in for-profit facilities were in the highest RUG categories, compared to 18% in nonprofits and 16% in government-owned facilities.

Investigators added that for-profit chains were most likely to charge more and extend stays.

The report states many operators “may be routinely placing beneficiaries into higher paying RUGs” regardless of whether such coding is justified.
Share this article:

More in News

CMS updates coding instructions for hospice site of service, principal diagnosis

CMS updates coding instructions for hospice site of ...

A new Medicare hospice manual update includes instructions for which principal diagnosis codes are acceptable, and clarifies which codes should be used for services in a skilled versus non-skilled nursing ...

Vast majority of nursing home residents chronically constipated, and it's not well ...

Chronic constipation is highly prevalent in nursing homes and not well controlled, leading to a high likelihood that residents develop fecal impaction, according to findings from a first-of-its kind study.

Federal judge dismisses nursing home 'kickback' case; upholds large X-ray company's 'swapping' ...

The way mobile x-ray company Mobilex bills nursing homes is acceptable, a federal judge recently determined. Mobilex is the nation's largest provider of mobile diagnostic services. It had been facing whistleblower charges that it effectively paid kickbacks to nursing homes through an arrangement known as ...