OnPoint Analytics

John Oliver Shines National Spotlight on Long Term Care Billing Practices Studied by OnPoint Expert Vivek Shah, Ph.D.

The April 11, 2021 episode of Last Week Tonight with John Oliver focused on long term care facilities for elderly and disabled Americans, and some of the problems they currently present. The show highlighted questionable practices such as understaffing and performing medically unnecessary services for the purpose of maximizing billings to Medicare. Oliver also noted that several corporations that operate long term care and skilled nursing facilities have paid multimillion dollar settlements to resolve allegations of this kind in False Claims Act litigation.

OnPoint expert Dr. Vivek Shah studies and provides expert reports and testimony about Medicare billing practices by skilled nursing facilities. His testimony and reports have addressed practices like the ones described on Last Week Tonight.

Noting how amounts paid to skilled nursing facilities by Medicare were dependent upon therapy minutes provided during specific billing assessment periods, Dr. Shah has analyzed the ramp up in volume of therapy minutes provided during those periods as compared to other periods during which the level of therapy did not affect reimbursement rates. Dr. Shah has also analyzed timesheet data to highlight understaffing at nursing homes and how it leads to concurrent billing by therapists who oversee multiple residents simultaneously. Dr. Shah has estimated the potential Medicare overpayments to skilled nursing facilities as a result of these practices.