United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1995-03-30 monographic deposited born digital GA 1.13:HEHS-95-23 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-95-23 P0b002ee18039cc5d f:he95023 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-95-23 machine generated eng fdlp REPORT GAOREPORTS-HEHS-95-23 HEHS-95-23 Medicare programs Nursing homes Billing procedures Therapy Medical fees Overpayments Medical expense claims Insurance claims Health insurance cost control Beneficiaries Medicaid Program Letter Report HEHS Nursing homes and rehabilitation centers are taking advantage of ambiguous payment rules and lack of guidelines to bill Medicare at inflated rates for therapy services. State averages for physical, occupational, and speech therapists' salaries range from about $12 to $25 per hour, but Medicare has been charged upwards of $600 per hour. The extent of overcharging and its precise impact on Medicaid outlays are unclear; however, billing schemes uncovered in recent years suggest that the problem is nationwide and growing in magnitude. Extraordinary markups on therapy can result from providers exploiting regulatory ambiguity and weaknesses in Medicare's payment rules. Payment rules and procedures developed when the therapy industry was much smaller and less sophisticated have proved no match for increasingly complex business practices designed to generate increased Medicare revenue and skirt program controls. Although the overbilling problem has been known since 1990, no action has been taken to close loopholes that allow payment for these overcharges. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-95-23/html/GAOREPORTS-HEHS-95-23.htm GAO/HEHS-95-23 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-95-23 Letter Report GAO/HEHS-95-23; Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes; Medicare programs Nursing homes Billing procedures Therapy Medical fees Overpayments Medical expense claims Insurance claims Health insurance cost control Beneficiaries Medicaid Program