The Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) found that “inappropriate payments” amounted to about 5.6 percent of all Medicare payments made to skilled nursing facilities (SNFs) in 2009.
Errors affected one-quarter of the Medicare SNF claims, and the errors led to $1.5 billion in inappropriate payments, HHS OIG officials said in an SNF billing report.
Medicare paid a total of $27 billion for SNF services in 2009.
Medicare is not normally supposed to pay for true long-term care (LTC) services, but it does pay for nursing home care — SNF services — for Medicare enrollees who need that kind of care to continue to recover after they leave the hospital.
The Centers for Medicare & Medicaid Services (CMS) changed the SNF reimbursement formula in a fashion that increased SNF payments in the fiscal year that started Oct. 1, 2010. CMS then cut SNF spending by $3.9 billion in fiscal year 2012, to make up for what CMS officials regard as being overpayments made in fiscal year 2011.
The Obama administration has proposed cutting an additional $65 billion from SNF reimbursement spending over the next decade.
The HHS OIG investigators conducted their analysis by reviewing a random sample of 499 2009 SNF claims for 245 stays, then having the reviewers decide whether the SNF claims were consistent with the patients’ medical records.