GOV’T AUDIT INSIDER: OIG finds Medicare overpayments to skilled nursing facilities in Puerto Rico
Healthcare Auditing Weekly, February 22, 2005
Medicare improperly paid approximately $25,690 to skilled nursing facilities (SNF) that were under the administrative responsibility of Cooperativa de Seguros of Puerto Rico, according to an OIG audit report. To qualify for Medicare reimbursement, a SNF stay must be preceded by an inpatient hospital stay of at least three consecutive days, not counting the date of discharge, which is within 30 days of the SNF admission. More than 75% of the SNF stays in Cooperativa's database were not compliant with these regulations, according to the report. The OIG recommends that Cooperativa either recover the overpayment or support the eligibility of the disputed stays, and initiate provider education about qualified SNF stays. During the audit, the OIG did the following:
Click here to read the audit report, "Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of Cooperativa de Seguros de Vida de Puerto Rico," (A-05-04-00062) issued January 19.
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