OIG Report on Questionable SNF Claims
The OIG has released a report entitled "Questionable Billing by Skilled Nursing Facilities." According to the OIG, skilled nursing facilities (SNFs) increasingly billed Medicare for higher paying source utilization groups (RUG) from 2006 to 2008, while beneficiary characteristics remained largely unchanged. For instance, payments for ultra high therapy increased by almost 90% during this period. For-profit SNFs were more likely than nonprofit or government SNFs to bill for higher paying RUGs, the OIG found. The OIG recommends that CMS: adjust SNF rates if necessary; modify the method for determining therapy needs; enhance monitoring of SNFs that bill for higher paying RUGs; and follow up on SNFs identified as having questionable billing.
