Many Nursing Homes Overbill Medicare for Patient Therapy

According to a recent report by the inspector general of the Department of Health and Human Services, many nursing homes overbill Medicare for physical therapy services and regularly file claims for Medicare payments for the highest and most expensive levels of therapy regardless of what nursing home patients required.

The inspector general, Daniel R. Levinson, stated that Medicare has seen a significant increase in nursing homes classifying ever increasing numbers of residents as needing the highest level of therapy available, and then providing the exact amount of therapy required by Medicare standards in order to qualify for the enhanced level of payment for this service.

In order to qualify for receipt of payments for “ultrahigh” therapy, a skilled nursing facility must provide therapy to a resident for 720 minutes or more during a seven-day assessment period, and “they increasingly provided exactly 720 minutes,” Levinson said.

These extra billings cost Medicare $1.1 billion in 2012-13, according to Levinson.

Andrew M. Slavitt, acting administrator of the Centers for Medicare and Medicaid Services agreed with the findings of the Department of Health and Human Services.  He stated that the current payment system actually creates an incentive for nursing homes to “provide as much therapy to a resident as that resident can tolerate.”

Meanwhile, in March, the Medicare Payment Advisory Commission urged Congress to completely revamp payments to nursing homes, citing the fact that Medicare payments to nursing homes have been at least 10 percent higher than the cost of care for 14 years in a row.

The take-away? This is an incredible expense borne by all taxpayers, and is not only in excess of what most nursing home residents may need in the way of physical therapy, but may also result in harm to residents in foreseeable falls or other injuries during therapy.

(Source: New York Times)