Policy & oversight
Federal Audit Finds About 19.5 Million Dollars in Improper Medicare Part B Payments for Nursing Home Patients
An OIG audit released July 15 found that 91 of 150 sampled Medicare Part B claims for nursing home residents failed program requirements, with missing documentation as the most common flaw.
By the Goodsurance editorial teamJuly 12, 2026
A federal audit has found that a Medicare claims processor made approximately 19.5 million dollars in improper payments for services billed to Medicare Part B on behalf of patients residing in nursing homes.
The Office of Inspector General of the Department of Health and Human Services released the audit on July 15, 2026. It examined claims processed by Novitas Solutions, a Medicare Administrative Contractor that handles Part B billing in several states. Auditors reviewed 150 claims for evaluation and management visits, psychotherapy sessions, and podiatry services provided to nursing home residents during stays not covered by Medicare Part A.
An OIG audit found about 19.5 million dollars in improper Medicare Part B payments tied to nursing home patients, mostly driven by missing documentation.
Of the 150 sampled claims, 91 did not meet Medicare requirements. The most common shortcomings included documentation that did not support the service billed, missing or incomplete clinical notes, and services billed at a complexity level not warranted by the patient's condition. Evaluation and management visits, psychotherapy, podiatry, and wound care were the most frequently billed Part B services for nursing home residents during the period reviewed.
The OIG recommended that Novitas Solutions refund the improperly paid amounts to Medicare and strengthen its review of nursing home claims. CMS agreed with the findings and said it would direct Novitas to take corrective action.
In plain words
A federal watchdog called the OIG checked Medicare bills from nursing homes. It found that a company called Novitas Solutions, which processes Medicare bills, made about 19.5 million dollars in payments that did not follow Medicare rules. Auditors checked 150 bills and found 91 were wrong. The most common problem was missing paperwork. The bills were for doctor visits, mental health therapy, and foot care for nursing home residents. The OIG said the company must pay back the money and improve how it checks bills. Medicare officials agreed.
Understand the basics first
Source: OIG
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