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

RACs collected nearly $2 million from skilled nursing facilities last year, report ...

Recovery Audit Contractors recovered $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released Monday.

OK nursing home worker threatened to behead colleague in a terrorist act, ...

Police in Oklahoma City have arrested a nursing home worker who allegedly threatened to behead another staff member out of solidarity with the Islamic State in Iraq and Syria, according to news sources.

Jewish Home Lifecare named Innovator of the Year

Jewish Home Lifecare named Innovator of the Year

Jewish Home Lifecare won the top award in the Innovator of the Year category in the third annual McKnight's Excellence in Technology Awards competition.