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Major California Nursing Home Chain Overbilled Medicare $100 Million by ?Upcoding? Patients

By Beth Janicek

North American Health Care (NAHC), a major California Nursing Home chain, allegedly falsified records and overbilled Medicare by $100 million. According to court documents, NAHC employees have been ordered to change patient charts to make patients appear more sick or frail. A spokesman for ManorCare said,

'Residents are coded into billing categories based on their medical and rehabilitative needs.'

NAHC bills shows a pattern of 'upcoding' in which nursing homes overbill Medicare by assigning patients billing codes that charge more money than necessary.

NAHC's president and chief executive, John Sorenson said that he was unaware of any anomalies. He said that his facilities have received high-quality ratings from Medicare and that he is cooperating with the HHS inspector general's investigation.

'They have not told me about any upcoding or wrongdoings at all. We have been honest and forthright business practices in place…We don't have any need or reason to be doing any kind of upcoding. That would be completely wrong.'

After the new Medicare payment system went into effect, federal analysts started to detect billing anomalies in skilled nursing facilities. Marie-Therese Connolly, who headed the Justice Department's Elder Justice and Nursing Home Initiative from 1999 to 2007 said,

"Upcoding, billing for services not rendered, and billing for worthless services have been significant problems for years, costing taxpayers many millions, if not billions of dollars.'

Originally posted at InjuryBoard by Beth Janicek

Full post as published by San Antonio Personal Injury Lawyer on April 03, 2010 (boomark / email).