Nursing Home Fraud

Nursing Home Care Fraud

 

Medicare doesn’t generally pay for long-term nursing home care. However, Medicare Part A covers medically necessary, short-term care in a skilled nursing facility (SNF) within a nursing home under certain conditions. SNFs play a crucial role in providing therapy and rehabilitation after you or a loved one have suffered a debilitating illness or stroke. After a qualifying stay in the hospital, Medicare beneficiaries frequently need some time in a SNF to regain their strength.

However, some unscrupulous facilities (even some associated with national chains) have taken to fraudulent billing.

Report potential nursing home care fraud, errors, or abuse if:

  • You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for:
    • Services that were not deemed medically necessary by your doctor
    • Therapy services or visits that were billed to Medicare but were not provided
    • More expensive services than what you were provided
    • More therapy than what you were provided
    • Skilled nursing services for dates after you were released from the SNF 
  • You are forced to remain in a SNF until your Part A benefits have expired even though your condition has improved, and you wish to change to home health care services

To learn more about tips related to nursing home care fraud, click here
To learn how to read you Medicare Summary Notice (MSN) and Explanation of Benefits (EOB), click here.

Report Suspected Fraud

To report suspected fraud, click here.


SMP Resources

Nursing Home Care Fraud Tip Sheet

Other Resources

OIG Operation CARE

5 Things to Know About Nursing Home Fraud And Abuse Video

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