Investigators Find Medicare Spent $5 Billion on “Poor” Skilled Nursing Care in 2009

Medicare paid billions of dollars to nursing homes that delivered poor quality-of-care services, federal investigators found. 

For 37% of stays, skilled nursing facilities (SNFs) did not develop care plans that met requirements or did not provide services in accordance with care plans, according to a report from the Department of Health and Human Services (HHS) Office of the Inspector General (OIG)

Medicare paid $5.1 billion for these stays in 2009, additionally finding poor quality care related to wound care, medication management, and therapy in skilled nursing facilities.

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While raising concerns about what Medicare is paying for, the Inspector General’s findings demonstrate that SNF oversight must be strengthened to ensure that these facilities perform appropriate planning in both care and discharge operations. 

In one case, five facilities did not provide adequate staffing and services to Medicare beneficiaries, neglect of which resulted in patients developing pressure ulcers, malnutrition, dehydration and side effects from not receiving medications.

In another, three facilities were charged with providing inadequate food and medication to beneficiaries. 

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The study arrives as part of a larger initiative about skilled nursing payments and quality of care, writes OIG. 

In fiscal year 2012, Medicare paid $32.2 billion for SNF services, which include skilled nursing care, rehabilitation and other services. 

Another study from OIG found that SNFs billed one-quarter of claims in error in 2009, totaling $1.5 billion in inappropriate Medicare payments. 

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Moreover, the study found that for 47% of claims, SNFs misreported information related to beneficiary assessment, which is used to create care plans. 

To reinforce its oversight of SNFs to ensure they are performing up-to-par, OIG recommended several suggestion to the Centers for Medicare & Medicaid Services (CMS). 

Revising regulations on care planning and discharge planning to reflect currents standards of practice would help CMS address the vulnerabilities described in the report, suggests OIG. 

Specifically, SNFs should be required to document in medical records the reasons why they did not provide services in accordance with care plans, while also adding a requirement that discharge planning be conducted by an interdisciplinary team to prevent hospitalizations.

Additionally, OIG recommends that CMS provide guidance to SNFs about care and discharge planning that stress the importance of addressing problem areas identified in the beneficiary’s assessment. 

OIG also expressed that it will provide CMS with a list of SNFs that failed to meet care planning and discharge planning requirements, or that provided poor quality-of-care. 

Written by Jason Oliva