Download This PaperOverbilling and Killing? An Examination of the Skilled Nursing Industry
85 Pages Posted: 15 Oct 2024
Date Written: October 15, 2024
Abstract
Skilled Nursing Facility (SNF) systems that provided excess rehab therapy just above revenue thresholds quickly begin upcoding previously unidentified comorbidities under the new PDPM billing regime. Patients at these opportunistic systems develop more than 50% greater preventable conditions and have twice as many verified reviews indicating abuse. Opportunistic systems mask adverse outcomes through underreporting to CMS. Instrumental variable estimates indicate that opportunistic SNF systems are responsible for an additional 35,000 hospitalizations and 30,000 deaths since PDPM was enacted, while overbilling Medicare $4.3 billion. Opportunistic SNF systems are spreading with more than 2.5 times the acquisition rate of accurate billing systems.
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John M. Griffin
University of Texas at Austin - Department of Finance ( email )
Red McCombs School of Business
Austin, TX 78712
United States
512-471-6621 (Phone)
HOME PAGE: http://www.jgriffin.info
