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Nursing Homes, Public Funds, & Overbilling

We hear it all the time: nursing homes do not have enough money to provide proper care to their residents. When neglect or abuse is uncovered and serious problems are identified–often insufficient staffing levels–then the first line of defense is usually the difficulty these companies have in bringing in enough money to pay for the care needed. Of course, the actual front-line care workers are rarely to blame for issues like lack of staffing; they are just doing their job the best they can, often with unmanageably low support. But just because a company claims to lack resources does not mean that they actually do not have the funds they need to provide proper care.

After all, most of those making these complaints are private businesses. Why would they be running these facilities if it was not profitable? Would they continue in business if the cost of providing adequate, safe care was more they they received from those paying for it? The truth is, they wouln’t. The owners and operators continue to make steady profits on these businesses, and claims about lack of resources often just mean one thing: they do not want to cut into their healthy profit margin.

There is no harm in making a profit in business–that’s the whole point. But when your business is providing skilled medical care to others, then it is not acceptable to make excuses of profit when poor care leads to serious harm to those vulnerable consumers counting on you. Sadly, that is exactly what happens in so many corners of the skilled nursing home business world.

Nursing Home Medicare Overbilling
The reality is that much of this care is actually paid for by the public, via Medcaid and Medicare programs. These businesses often complain that the public funds are insufficient. Yet, a new report discussed in the Wall Street Journal (no friend of attacking business) recently explained that U.S. skilled nursing facilities may actually be overbilling public coffers. The report notes that every year there may very well be $1.5 billion in overcharges to Medicare from companies making claims about providing certain nursing home care.

According to a new study released this week from the U.S. Department of Health and Human Services nearly 1/4 of all nursing home Medicare billing is inaccurate. The report finds that the main problem stems from “upcoding.” That refers to situations where the bill to Medicare is for services that were more extensive or more expensive than the services actually provided. In addition, at times there were some bills for things which were not actually provided. Much of this refers to treatments like speech therapy, occupational therapy, and phsical therapy.

One inspector general familiar with the matter summarized by noting that, “They’re billing for therapy they don’t provide or which the patient doesn’t need. […] What makes this report stand out is the sheer amount of dollars inappropriately spent.”

This report should be a reminder to all local community members that excuses made by these businesses about providing insufficient care is just that–an excuse. These entities cannot pretend that their drive to maximize profits for owners and shareholders is akin to not having enough funds to ensure proper staffing, training, and equipment to keep their residents safe and secure. When they fail to meet reasonable standards, they must be held accountable Only then may they eventually recognize that it is not acceptable to allow residents to suffer in order to keep profit margins steady.

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