OIG: Nursing homes are gaming Medicare

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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.
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