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CMS lost $84M in two years for ineligible nursing home stays
Modern Healthcare

The CMS pays millions of dollars a year to nursing homes for taking care of older adults who don’t qualify for coverage, according to an investigation by HHS’ inspector general.

The IG’s report, released Wednesday, includes steps the CMS should take to fix the problem; but in a written response, CMS Administrator Seema Verma rejected some key recommendations.

Based on a review of nursing home payments from 2013 through 2015, the IG found that the CMS paid nursing homes an estimated $84 million for patients whose records did not contain the required three-day hospital admission. Although that’s a relatively small amount compared to the $85.9 billion the CMS paid nursing homes during the same period, IG investigators said such improper payments are accumulating year after year. The IG discovered the problem by comparing hospital and nursing home payment data.