OIG to investigate Part A billing, ED transfer practices by nursing homes

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HHS Inspector General Daniel Levinson
HHS Inspector General Daniel Levinson

The Office of Inspector General released its Fiscal Year 2015 Mid-Year Update this week, and it includes several initiatives important to long-term care operators.

OIG will be taking a closer look at Medicare Part A billing by skilled nursing facilities, based on previous OIG reports that found SNFs increasingly billed for the highest level of therapy, despite beneficiary characteristics remaining largely unchanged. In addition to high billing, OIG also found that SNFs billed one-quarter of all 2009 claims in error, resulting in $1.5 billion in erroneous Medicare payments.

The rate of Medicaid beneficiary transfers from group and nursing homes to hospital emergency rooms also will be reviewed by OIG, since high occurrences of emergency transfers could be a sign of poor quality of care.

Whether or not state survey agencies verified nursing home deficiency correction plans will also be evaluated. This stems from a review that found one state survey agency did not always verify that homes corrected deficiencies found during surveys. State verification of deficiency correction plans is required by federal regulations and is completed through onsite reviews or evidence of correction.

The OIG update also includes plans to review state background check costs and procedures for prospective long-term care employees who will have direct access to patients.