Pennsylvania’s Medicaid agency wrongly paid more than $75,000 to 13 skilled nursing facilities that had been sanctioned for poor quality of care between 1999 and 2003, costing the federal government $40,000, according to the Department of Health and Human Services Office of Inspector General. It was reported in an audit entitled “Medicaid Denial of Payment Remedy for Sanctioned Nursing Homes in the Commonwealth of Pennsylvania.”
The Nursing Home Reform Act of 1987 says states must randomly survey nursing homes at least once every 15 months, unannounced. Facilities can be placed under “denial of payment” sanctions if they have a certain number of deficiencies, the report said.
One of 13 of the facilities that received improper payments returned nearly $3,000 to the state.
The IG blamed the state’s pre-payment system and post-payment reviews for the payments. The IG also said the Centers for Medicare & Medicaid Services had 101 homes that were sanctioned improperly tagged in its system. The IG asked Pennsylvania’s Medicaid agency to refund the federal share of the unallowable payments.
