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Medicare Compliance & Reimbursement

COMPLIANCE:

Part B Payments 'Vulnerable To Fraud,' Watchdog Says

Published on Thu Jan 25, 2007

OIG is watching doctors' nursing home visits.

Nursing homes could be hotbeds of inappropriate billings, warns one government agency.

Physicians' Part B claims for services to patients who are in a nursing home but not during a Part A-covered stay are "particularly vulnerable to fraud and abuse," warns the HHS Office of Inspector General (OIG) in a new report (OEI-05-06-00240). Congress has asked the OIG to keep an eye on doctors billing for services that the nursing home may already be billing for separately.

The OIG's new report ("Medicare Part B Services For Nursing Home Residents") doesn't draw any conclusions. But it does point to a lot of money going to doctors billing in nursing homes, and that may indicate duplicate billings. Medicare paid $5.3 billion for Part B services for non-Part A nursing home patients.

Ten services accounted for 79 percent of these billings. These included "minor procedure," "nursing home visit," "lab test," "specialist" and "standard imaging." The OIG says it will be looking at these areas and gathering more up-to-date information to figure out how many payments overlapped with services the nursing home billed.
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