A recent report from HHS-OIG reveals that Medicare paid $1.5 billion in improper claims for skilled nursing care in 2009. This astounding sum represented nearly 6% of the $26.9 billion paid overall to skilled-nursing facilities in 2009. Notably, 25% of all Medicare claims submitted by skilled nursing facilities had “errors,” and the vast majority of the “errors” were improperly upcoded for ultra-high therapy that was not medically necessary.
Needless to say, with “errors” skewing toward higher Medicare reimbursements, outright fraud was and is pervasive in the skilled nursing care industry. This disturbing trend might partially explain the recent rise in Medicare payouts for such services, which have increased to over $32 billion in fiscal year 2012.
As the baby boomer generation ages into Medicare, the country will face rising entitlement spending and mounting federal debt. Ridding the Medicare program of fraud would certainly lessen some of these financial concerns. According to HHS-OIG, the government should focus some of its enforcement efforts on skilled nursing care providers.
More information for whistleblowers is located at the Nolan Auerbach website.