South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

Naples Daily News had an article about Medicare overpaying nursing homes.  Watchdog groups have warned about the overpayment months ago.  The already extremely profitable nursing home industry is getting an extra $1.5 billion from Medicare despite a call from an independent Medicare advisory panel that reimbursement has been inflated for the past three years and needs to be scaled back.

“The windfall to skilled nursing facilities comes with no strings attached and there is no reason to believe this windfall will help improve the quality of care or quality of life for nursing home residents,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy Inc., in Washington, D.C.

The overpayment remains even though the Medicare Payment Advisory Commission, an independent advisory group to Congress, recommended in May that the rates be adjusted because nursing homes are being overpaid. The Bush Administration decided this past month to "study" the issue further.

The Center for Medicare has been overpaying nursing homes since January 2006 after expanding the list of categories used in determining patients’ medical status for purposes of reimbursement  .By not addressing the issue now, the nursing home industry will reap an extra $780 million next year, Edelman said.

An Office of Inspector General report in 2006 found that 22 percent of nursing home claims were overcoded for higher reimbursement, he said.

The system used to determine reimbursement to nursing homes is complex. One component alone involves a patient evaluation form with 509 questions, Hamilton said. The forms help determine the nursing home’s reimbursement rates.  This raises questions about how much time staff members have to do the evaluation, how trained they are and whether the patient’s medical record matches the care rendered, Hamilton said.

On a second front, the nursing home industry is receiving a 3.1 percent inflation adjustment that will mean getting an additional $710 million next year from Medicare.  MedPAC had reviewed nursing homes’ operating margins and recommended no cost adjustment to the federal government but the inflation increase is moving forward.

 

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Dan Frith wrote the following blog article about improper evictions in nursing homes.  The Wall Street Journal ran an interesting article on August 7 about America's nursing homes wrongfully discharging residents. The article states that one in seven discharges from Washington, DC area nursing homes are improper.

Why are nursing homes wrongfully and illegally kicking out their residents? What else...money! You see most (approximately 70%) of nursing home residents are Medicaid beneficiaries and Medicaid sets the reimbursement rate for their stay. Medicare, which pays a higher rate, is usually only available for about 100 days of care in a nursing home. Nursing homes want the higher income provided by Medicare, long term care insurance, or private pay by the resident. They don't want the low rates paid by Medicaid.

Under federal law a resident can be discharged only for the following reasons:

1. The resident is well enough to go home.

2. The facility can no longer provide the care needed by the resident.

3. The resident is endangering the health or safety of others.

4. The facility closes its doors.

5. The resident (or Medicaid, Medicare, etc.) fails to pay the bills.

Know your rights. Don't let nursing homes kick out your loved ones just because they desire to make more money.

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A newly released poll from Zogby International shows that 63% of respondents oppose President Bush's proposed nursing home Medicare cuts.

Also, 61% of those surveyed would be less likely to vote to re-elect their representative in Congress if he or she voted for the president's plan containing Medicare reductions. Bush's proposed budget would slash $24 billion to the nursing home benefit over five years. Zogby conducted the poll for the American Health Care Association, a major lobbying group for the nursing home industry.

Other results of the poll: 50% of respondents say that any nursing home benefit cuts would have "a negative impact on the quality of care for seniors" and 73% say they would support a presidential candidate who will not reduce Medicare funding for nursing homes.

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McKnight's website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?

The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services.  As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.

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Here is an article about a nursing home in Arizona losing its Medicare and Medicaid funding because of patient neglect.   This action is the only one the multi-chain corporation understand.  Government oversight must be increased and serious consequences of neglect must be felt by the corporations.

Some Evergreen Foothills Health and Rehabilitation Center residents would have to be relocated to a facility capable of providing good care. The state is working to move those patients.

Arizona Department of Health Services records paint a disturbing picture. Problems cited include: failing to investigate injuries to rule out abuse; failing to provide regular catheter cleansing for one patient; and failing to notice when one patient had three broken ribs.

Evergreen's corporate defense attorney stressed that, although Medicare and Medicaid funding will officially be cut next month, the state is allowing the center to remain open for now.  I am sure that is a relief to the neglected residents who remain.

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The Bush Administration has decided to change the Medicare rules to prevent payment of "preventable" injuries.  Who decides what is preventable? How is that decided?  Here is part of the article I read:

In a significant policy change, Bush administration officials say that Medicare will no longer pay the  costs of treating preventable errors, injuries and infections that occur in hospitals.

Under the new rules, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”  

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.

Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.

 

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