Problems identified in 94% of claims reviewed during 11-month period in 2002- 2003

The U.S. Department of Health and Human Services’ Office of the Inspector General released a report last month recommending that Carlyle-ManorCare’s Heartland Health Care Center of Bedford, Texas refund $158,000 to the Medicare program and provide training to its staff on SNF medical necessity and documentation requirements. While seeking regulatory approval to purchase ManorCare last year, Carlyle issued a “Patients First” pledge promising to provide education and training to its staff. However, Carlyle-ManorCare has fought back against recent efforts by caregivers at ManorCare’s Towson, MD facility to secure a fully funded training program.

The OIG’s report has now been referred to an HHS action officer who will make the final decision on what steps to take. The OIG’s recommendations follow its finding that in 94% of the claims it reviewed the facility provided residents with services that were either medically unnecessary at the skill or resource level claimed, or not adequately supported by documentation.

Medically unnecessary services and billing errors in skilled nursing facilities were projected to cost the Medicare program more than $352 million in Fiscal Year 2007, according to a government report released earlier this month. The report is available at https://www.cms.hhs.gov/apps/er_report/index.asp.

The OIG’s full report may be viewed at http://www.oig.hhs.gov/oas/reports/region6/60700045.pdf