Costs & IRMAA
OIG: A Medicare Billing Contractor Improperly Paid an Estimated 19.5 Million Dollars for Doctor Visits and Therapy in Nursing Homes
An audit of Novitas Solutions found that more than half of sampled claims for evaluation and management visits, psychotherapy, and podiatry services provided to nursing home residents did not meet Medicare documentation requirements.
By the Goodsurance editorial teamSeptember 6, 2026
The Office of Inspector General found that Novitas Solutions, a Medicare Administrative Contractor, made an estimated 19.5 million dollars in improper payments for certain Medicare Part B services provided to patients living in nursing homes, according to audit report A-06-21-04002, published in July 2026.
The OIG reviewed claims for the period from October 1, 2018 through September 30, 2019 and sampled 150 claims covering evaluation and management visits, psychotherapy sessions, and podiatry services provided to nursing home residents. Of those 150 sampled claims, 91 did not meet Medicare requirements or could not be supported by available documentation.
A Medicare claims contractor made an estimated 19.5 million dollars in improper payments for nursing home visits, a federal audit found.
Medicare Administrative Contractors such as Novitas process and pay claims submitted by providers. The audit does not allege that nursing homes or individual providers acted improperly. The OIG identified documentation gaps, such as missing or insufficient records to justify the services billed, rather than services that were not rendered at all.
OIG recommended that Novitas strengthen its claims review procedures and provide annual education to providers and their billing staff about documentation standards for nursing home services. Novitas agreed with both recommendations.
Medicare Part B covers services such as physician visits, mental health treatment, and foot care even when a beneficiary lives in a nursing home rather than a hospital. Those services must meet specific documentation requirements to qualify for reimbursement.
In plain words
A company called Novitas Solutions processes Medicare bill payments in some states. A government watchdog checked how Novitas paid for doctor visits and therapy given to people living in nursing homes. It found that about 19.5 million dollars in payments did not follow Medicare rules, mostly because providers did not have the right paperwork. Novitas agreed to improve its process and help providers understand what records Medicare requires.
Understand the basics first
Source: OIG
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