Why SNFs draw enforcement attention
Skilled nursing facilities bill Medicare Part A for short-term rehabilitation and daily room-and-board rates tied to patient acuity. High reimbursement for therapy and skilled services creates pressure to maximize billable minutes and length of stay.
Common fraud patterns
Providing the highest level of therapy regardless of patient need, keeping patients beyond medical necessity, billing for services not documented, and kickbacks to hospital discharge planners appear in public settlements and qui tam complaints.
Who sees the problems
Therapists, MDS coordinators, nurses, social workers, and billing staff often know when therapy minutes on the chart do not match what patients could tolerate — or when admissions are driven by revenue targets rather than clinical need.
Reporting paths
State survey agencies and OIG accept complaints. Systematic billing fraud may support a qui tam case with potential relator rewards. Document patterns lawfully and consult counsel promptly. This guide is educational, not legal advice.