OIG monitors nursing home fraud
Healthcare Auditing Weekly, February 13, 2007
As part of a requirement mandated by Congress, the OIG has begun reviewing potentially excessive or duplicate billing of Medicare Part B services for nursing home residents not in a Part A-covered stay.
According to its initial report, Medicare allowed $5.3 billion for Part B services provided to 1.8 million nursing home residents who were not in a Part A-covered stay in 2002.
The $5.3 billion represents 5% of the total amount that Medicare allowed for all Part B services during 2002.
Ten categories of service account for 79% of payments for services provided to the nursing home residents. In addition, payments varied by state for each of the top 10 categories.
The OIG found in previous studies that Medicare Part B payments for beneficiaries residing in nursing homes are vulnerable to fraud and abuse. To protect the integrity of these Medicare payments, Congress required OIG to monitor billing of Medicare Part B services for nursing home residents not in a Part A-covered stay. The OIG also plans to review more current data to help identify potential patterns and areas of questionable billing.
Click here to read the full OIG report.
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