George Breen Quoted in “OIG Adds Review of Part A Claims to the 2014 LTC Work Plan

Billing Alert for Long-Term Care

George Breen, Chair of the firm's National Health Care and Life Sciences Practice Steering Committee, in the Washington, DC office, was quoted in an article titled "OIG Adds Review of Part A Claims to the 2014 LTC Work Plan."

Following is an excerpt:

The long-term care industry can expect continued scrutiny regarding Medicare billing in 2014, as the OIG intends to release four reports this year specifically geared toward long-term care practices.

Part A billing practices among SNFs have been added to the list of reports expected to be released this year, according to the OIG Work Plan for Fiscal Year 2014 released at the end of January. ?...

The OIG's announcement that Part A services will be included in its 2014 Work Plan fits into an overarching position that the government has focused on recently in all areas of healthcare: improving quality of care while also eliminating wasteful spending, says George Breen.

"The whole notion of whether or not the level of care that is provided to the beneficiary is in fact medically necessary is a theme that goes across the healthcare spectrum," he says. "The ways in which SNFs are getting paid may be different, but the issue of whether the level of care is necessary, and whether the services are necessary for that particular patient's condition, is something the government is focusing on more and more." ?...

"You want to at least try and figure out whether your billing pattern is such that it would be more likely that the government is going to look at you more than your competitor, and if it is, what story can you tell and how can you explain why your picture is different than your competitor's picture," Breen says. "Oftentimes there are perfectly legitimate reasons for it, but unless you're prepared to make that presentation then it gets lost in the shuffle."