Report warns of possible Medicare fraud in nursing homes

Auditors from the Health and Human Services Department are raising new concerns about possible fraud in Medicare payments to nursing homes.

The HHS Office of the Inspector General (OIG) said fraud, waste and abuse are the most likely explanation when nursing homes collect payments that are far higher than the national average.

The findings are part of a report on situations in which Medicare does not cover a patient's stay in a nursing home but does pay for certain, specific procedures during the stay. One category of services includes drug treatments, medical equipment and other supplies. Some nursing homes were paid more than three times the national average for those services, the OIG said.

The report says some of those payments turned out to be justified upon further review — for example, one high-cost facility maintained its own specialty unit. But "explanations are limited for extremely high average daily payments," the report warns.

The average cost for some patients was as high as $160 per day, compared with a national average of $3.39.

"Such high average daily payments lend themselves to concerns of potential fraud, waste, and abuse," the OIG said.