The AP (9/6) reported that Life Care Services, of Des Moines, and a California nursing home company called ParkVista “agreed to pay a $3.8 million settlement for what federal officials say was overbilling of Medicare” for “unreasonable and unnecessary” rehabilitation services for nursing home residents. 67 more words
Tags » Medicare/medicaid
The U.S. Department of Justice has intervened in two False Claims Act lawsuits brought by whistleblowers who say that for years, UnitedHealth Group Inc. 21 more words
HHS Agency Substantiates Watchdog Claim Of Rampant “Upcoding” in Medicare Advantage.
Fred Shulte of the Center for Public Integrity (8/7) reports on an investigation conducted by the Department of Health and Human Services Agency for Healthcare Research and Quality, which found that “Medicare made nearly $70 billion in ‘improper’ payments — mostly overcharges from inflated risk scores — to Medicare Advantage plans from 2008 through 2013 alone.” The Center for Public Integrity conducted an earlier investigation that uncovered the same billing inconsistencies, but also found that “risk scores rose much faster in some health plans than others and that federal officials repeatedly yielded to industry pressure to minimize efforts to recoup overpayments.” These overcharges are referred to as “upcoding.” 175 more words
Some Seniors To Be Exempt From Medicare Three-Day Rule As Part Of Pilot Study.
The Washington Post (7/20, Jaffe) reported that some seniors will be exempt from the “controversial requirement that seniors be admitted to the hospital for at least three days to qualify for follow-up skilled nursing home care.” This waiver of the three-day rule, which is part of a pilot program aiming to test ways in which to develop better care at a lower cost, “applies even to patients kept for observation, which is considered an outpatient service. 77 more words