SKILLED NURSING CARE MEDICARE FRAUD

Under an extension of Medicare Part A coverage, post-hospital skilled nursing care exists for qualifying patients. To qualify, a patient otherwise appropriate for Medicare must show a qualifying hospital stay of three or more days within 30 days before entering the skilled nursing facility and a physician mus order procedures for the patient that are appropriate only at a skilled nursing facility (SNF). The physician must certify that the patient’s condition should improve. There are several kinds of fraud which have been uncovered by Congressional investigators and which are being reported by whistleblowers working for rehab companies including:
*Aggressively recruiting hospital patients who are not appropriate for skilled care;
*”skilling” patients who do not require and cannot benefit from physical, occupational or speech therapy;
*creating improper relationships between SNF’s and hospices where patients are shuffled between benefits to increase billing without regard to the patient’s well being;
*Improperly extdning patient stays beyond medical need;
*Paying illegal kickbacks between SNF’s and hospices for cross referrals, especially where hospice nurses provide free services to SNF patients.