OIG recommends training, repayment in Texas settlement
Healthcare Auditing Weekly, May 27, 2008
From July 2, 2002 to May 31, 2003, Heartland Health Care in Bedford, TX made 50 claims to Medicare totaling nearly $260,000, according to a recent Office of Inspector General (OIG) audit. The OIG found that Medicare overpaid for 47 of these claims for skilled services.
Medicare pays skilled nursing facilities (SNF) a daily rate to cover skilled services for Medicare beneficiaries. For billing purposes, SNFs complete a form that puts a patient in a specific resource utilization group, based on his or her needs.
The OIG found that the 47 overpaid claims were for services that were not medically necessary at the level provided in a SNF, not at the RUG level claimed, and not supported by medical documentation. The overpayments added up to $158,000.
The OIG recommended that Heartland refund Medicare $158,000 and provide its staff further training on SNF medical necessity and documentation requirements. Heartland disagreed with the OIG’s findings. However, the OIG is standing by its findings and recommendations.
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