'Ultra-high' Medicare billing program causes waste, abuse

The Washington Post: Federal investigators are examining a Medicare billing program to see if it is being abused by nursing home operators. "More than a decade ago, Congress ... created new 'ultra-high' billing categories intended to be used for only 5 percent of the patients needing highly specialized care and rehabilitation. But within a few years, nursing homes flooded the ultra-high categories with patients, contributing to $542 million a year in potential overpayments, federal analysts found." That number has continued to grow. One nursing home chain has 64 percent of its patients "billed in the highest category; the national average is 9 percent." Nursing home experts say overpayments across the country could reach into the billions of dollars (Higham and Keating, 3/29).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.