MASSDEVICE ON CALL — Due to incorrect filings, the Dept. of Health & Human Services may have paid out as much as $1.5 billion too much in payments to nursing homes in 2009, according to an investigation by the inspector general.
Most of the claims looked at were "up-coded," meaning that nursing homes billed Medicare for services that were more costly than what was provided or needed, Kaiser Health News reported. The excess payments made up more than 5% of the total $26.9 billion Medicare paid to nursing homes in 2009.
Nursing homes disputed the allegations, saying that the investigators failed to take into account patients’ individual needs.
"We found that they are billing for high amounts of therapy, and they don’t provide that," New York regional inspector general Jodi Nudelman told Kaiser Health News. "Or they’re billing for it and the patient doesn’t need that amount."
"Bureaucrats questioning these services after three years and saying they know what’s in the best interests of patients is not good medicine and doesn’t make sense," American Health Care Assn. and National Center for Assisted Living president & CEO Mark Parkinson said in prepared remarks.
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