For-Profit Nursing Homes More Likely to Overbill Medicare

Posted by PKSD Law Firm on Jan 07, 2011 in Nursing Homes and Elder Rights

For-profit nursing home companies led by Kindred Healthcare Inc. and Sun Healthcare Group Inc. are likelier than non-profit counterparts to overbill Medicare for the costliest services, according to a U.S. government report.

Medicare should investigate instances in which companies keep patients longer, charge more for care and classify clients for more extensive and costly services than needed, the study released today by the inspector general found.

The findings, based on audits of nursing-home billings from 2006 to 2008, "raise concerns about the potentially inappropriate use of higher-paying" billing codes, said the report by the Health and Human Services Department's Office of Inspector General.

It recommends that Medicare, the U.S. health insurance program for the elderly and disabled, consider changing its payment method for nursing home services.

The program covers as much as 100 days of nursing-home services for beneficiaries who require skilled care or rehabilitation following a hospitalization of at least three consecutive days. Care can be provided in a hospital or free- standing facility.

Medicare plans to target an undisclosed list of nursing homes with questionable billing practices, according to the report. The program specifically is examining special-nursing facilities for patients recovering from an injury or who are disabled.

Back to top