SNFs receive small portion of Medicare payouts to deceased beneficiaries, report says

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Skilled nursing facilities account for few of the problematic Medicare claims that are related to beneficiaries who were deceased at the time they supposedly received services, according to a new government report.

In 2011, the Medicare program paid out $23 million on these types of inappropriate and potentially fraudulent claims, according to the Department of Health and Human Services Office of the Inspector General (OIG). SNFs received $143,000, with 14 providers implicated in these reimbursements, according to OIG's analysis of Part A data. The report did not break down the exact circumstances of these claims, such as whether intentional fraud was involved or suspected.

Home health and hospice providers received even less money from these claims than did SNFs, although more providers were involved — 20 in home health and 32 in hospice, the report states.

The blended public-private insurance plans under Medicare Part C were involved in the majority of these questionable payouts. About $19.9 million in payments to deceased beneficiaries were made through Part C, according to the report.

The Centers for Medicare & Medicaid Services concurred with the recommendations contained in the OIG report. These include improving existing safeguards, such as by employing predictive analytics to identify providers and suppliers that are at risk for this type of fraud. Prepayment reviews could then be called for, if CMS decides it needs to verify these providers' or suppliers' claims.

Click here to access the complete report, issued Thursday.


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