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Medicare Fraud Not Limited to Home Health Agencies

Nov 26 | 2012  by

Home healthcare companies aren’t the only ones overbilling Medicare – nursing homes are doing it as well.  According to a report by the Department of Health and Human Services Inspector General, a review of nursing home Medicare bills found that about one-fourth of them were incorrect. 

This adds around $1.5 billion in annual costs to the Medicare program, according to the report.

Much of the incorrect billing involves upcoding, a common scheme where the facility submits bills to Medicare for more intensive services than actually performed to receive higher reimbursement.  Additionally, some facilities provide treatments to patients that are inappropriate or unnecessary.

“What makes this report stand out is the sheer amount of dollars inappropriately spent,” said Jodi Nudelman, New York Inspector General who oversaw the study.  These companies are “billing for therapy that they don’t provide or which the patient doesn’t need.”

Medicare accounted for 13.5% of Federal spending last year – and that percentage is expected to grow.  With estimates labeling 30% of U.S. medical spending as “unnecessary,” cutting fraud, waste, and abuse is a key part of reducing Medicare spending – $3.7 billion has been recovered in the past 3 years. 

The OIG has said that Medicare has made several significant changes but that more needs to be done to reduce inappropriate payments.  This systematic overbilling at the expense of taxpayers is unacceptable.

If you have questions or have witnessed a nursing home or other provider committing Medicare fraud, contact the experienced fraud team at Fausone Bohn, LLP.  Call Tariq Hafeez at (248) 380-0000 or contact us online.

To read the original article, please visit the Wall Street Journal.