Department of Health and Human Services

Office of Inspector General -- AUDIT

"Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of Riverbend GBA," (A-05-03-00015)

April 4, 2003

Complete Text of Report is available in PDF format (513 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This OIG report estimates that $11.6 million in ineligible Medicare Skilled Nursing Facility (SNF) payments were made under the administrative responsibility of Riverbend Government Benefits Administrator (GBA) during calendar years 1997 through 2001.  The overpayments occurred because of the absence of an automated cross-check between the Centers for Medicare and Medicaid Services Common Working File and the Fiscal Intermediary’s claims processing system to verify that a three consecutive day inpatient hospital stay occurred prior to SNF admission.  Riverbend generally agreed with OIG's recommendations.