This Washington Post article reads, “More than a decade ago, Congress set out to squeeze the fraud out of Medicare billing at nursing homes, requiring more precise justifications for costs. It created new ‘ultra-high’ billing categories intended to be used for only 5 percent of the patients needing highly specialized care and rehabilitation.”
But, over the years the nursing homes have been flooded with patients put in this category and facilities have been billing for more services than are being provided. The Department of Health and Human Services inspector general’s office is examining the fraud, waste and abuse that has resulted from the miscodings.