Medicare Compliance & Reimbursement

Skilled nursing facilities across the country could soon be asked to hand back Medicare dollars they've already been paid. In a quartet of recent audit reports, the HHS Office of Inspector General notes that Medicare contractors United Government Services, Admin-aStar, CareFirst of Maryland and Palmetto GBA overpaid SNFs for residents who weren't eligible for payment. In particular, the contractors paid SNFs without verifying that residents had a qualifying three-day hospital stay preceding the SNF admission. Some contractors point out that verifying the 3-day stay is difficult, if not impossible - a fact that is only likely to draw down more scrutiny on the issue. The errors resulted in AdminaStar paying $25.2 million too much, UGS overpaying by $23.3 million, CareFirst by $8.1 million and Palmetto by $14.1 million. The claims processors say they plan to recover the funds. Lesson Learned: In coming months, skilled nursing facilities should expect their contractors to aggressively tout compliance with the 3-day qualifying hospitals stay eligibility requirements. The reports are titled "Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of CareFirst of Maryland, Inc./UGS/AdminaStar/Palmetto GBA" (A-05-03-00026/A-05-02-00087/A-05-02-00086/A-05-02-00088). To see them, go to http://oig.hhs.gov/oas/oas/cms.html.