June 29, 2017
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If you pay taxes, you should take note of a recently released report by the the U.S. Inspector General about the improper Medicare billing practices by U.S. nursing homes.   In its report, the Office of Inspector General (“OIG”)  describes identifying in recent years that U.S. nursing homes have been submitting inaccurate, medically unnecessary, and “fraudulent” claims to Medicare.  In 2009 alone, one out of every four (25%) claims submitted by the U.S. nursing home industry was erroneous, resulting in 1.5 billion dollars ($1,500,000,000) worth of unjustified payments from Medicare (i.e., tax payors) to nursing home industry coffers.

The study found that the nursing homes misreported information about the condition of the patient in 47% of the patient’s MDS form (it stands for Minimum Data Set).  The MDS form is used by nursing homes to assess the patient’s condition, functional status, and expected and actual use of services.  This information is ultimately factored into the payments the nursing home facilities will receive from Medicare.  Even more concerning, the information from the MDS form is supposed to be used by the nursing homes to develop proper care plans that meet the patient’s specific needs.  With 47% of them being inaccurate, one has to wonder how many patients have care plans that are also improper.  Information noted by the OIG to be misreported by the nursing homes included therapy, special care such as IV medication, tracheostomy care, and pressure ulcers, among others.  Thus, not only is Medicare (tax payers) paying for improper services — they are paying for services that may be to the detriment of the patient’s health.

Patients have a right to receive a copy of any of the medical records, including the MDS form.  We recommend to our clients that they request a copy of the MDS from the nursing home to review for false information and other red flags that could impact the care they are or are not receiving.

We have previously reported upon the problem of improper Medicare billing practices.  At the same time, we have also reported on the pitifully poor care that is being provided by Indiana nursing homes and by the U.S. nursing home industry in general.

Tax payers, patients, families of patients, and concerned citizens have good reason to be outraged.  The nursing home industry can only get away with this if we let them.

A copy of the OIG report can be found here.

For more information generally about nursing home neglect and abuse in Indiana, check out Indiana Nursing Home Watch.

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