Medicare Paid $5.1 Billion for Inadequate Nursing Homes

Medicare paid $5.1 billion to nursing homes in 2009 that failed to meet quality-of-care requirements, U.S. government investigators said.

Reviewers found examples of poor quality of care, including services related to wound and medication management, the Department of Health and Human Services’ inspector general said in a report today. The analysis builds on a separate report last year that showed Medicare paid $1.5 billion more to nursing homes than they were owed in 2009 because the facilities erroneously billed a quarter of their claims.

“These findings raise concerns about what Medicare is paying for,” Daniel Levinson, the inspector general, said in his report.

Medicare, the U.S. health program for the elderly and disabled, paid $32.2 billion to nursing homes in the 2012 fiscal year. The inspector general today recommended that the Centers for Medicare and Medicaid Services strengthen regulations on care planning, increase surveillance of underperforming nursing facilities and more directly link pay to performance.

The CMS administrator, Marilyn Tavenner, agreed with the recommendations and said in a letter that her agency “recognizes the importance and impact of effective care planning and discharge planning on the quality of life and care for nursing home residents.”

Nursing homes are dealing with people whose needs change daily, requiring changes to their care plans, said Greg Crist, a spokesman for the Washington-based American Health Care Association, which represents the industry.

“Circumstances change, and our caregivers are adapting to meet new medical needs,” Crist said. “We’re more focused on health outcomes, and have seen them improve for our patients.”

To contact the reporter on this story: Alex Wayne in Washington at awayne3@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

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