Medicare paid $4.5 billion for the almost 37 percent of skilled nursing facility (SNF) stays in 2009 that did not meet care plan requirements or service requirements, according to a new Office of Inspector General (OIG) report.

Some cases have reached criminal status. George Houser, who owned and operated several SNFs in Atlanta, was sentenced to 20 years in prison and ordered to pay $6.7 million in restitution because he failed to buy food or basic nursing and hygiene supplies for 400 residents, OIG stated. The conditions of the facilities, including leaky roofs and inadequate trash services, led to insects and rodents in the SNFs and one patient death. Yet he received almost $33 million in Medicare and Medicaid funds.

OIG also discovered overbilled therapy, substandard services and poorly planned or mismanaged care.

Of note for honest providers is that OIG recommended the CMS further scrutinize SNF payments and make annual rate adjustments if necessary, according to OIG. It also recommends linking SNF payments to quality-of-care requirements.

You can read the full report on OIG’s website at

RAC News

HealthDataInsights, the recovery auditor for Region D, posted several issues approved in late 2012. Performant Recovery and Connolly also posted issues. See the chart below for more details.


About the Author

Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation’s leading independent authority on home healthcare business, regulation and reimbursement.

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