Cassie Friedenberger

OIG Study Raises Questions About Medicare Advantage SNF Denial Practices

The Office of Inspector General (OIG) recently released a month-long study report that revealed Medicare Advantage plans denied 12% of requests for admission to a skilled nursing facility (SNF). 95% of those denials were overturned on appeal, which supports that the care was medically necessary. The OIG report confirmed what SNF Providers have known for years, that patient care is delayed or denied by the Medicare Advantage Organizations (MAOs). The OIG noted that denials of…

Blog Series: Part 1 – Technical Issues in PDPM Coding and Billing

In this 3-part blog series, we will focus on issues that were identified in the recent OIG audit of PDPM records and MDS. The first area relates to a lack of documentation to support technical requirements. Billing and coding for medical services provided under the Centers for Medicare & Medicaid Services (CMS) should always be accurate and supported by requirements outlined in the regulations. For Skilled Nursing Facilities (SNF), billing for Medicare Part A is…

The Cost of Overlooking Monthly Exclusion Checks

On September 29, 2025, a home health company in Arizona, agreed to pay $20,000 to settle allegations of violating the Civil Monetary Penalties Law (CMPL). The Office of Inspector General (OIG) alleged that the home health company employed an excluded individual—someone prohibited from participating in any Federal health care program—as a home health aide. The individual’s services were allegedly billed to these programs, triggering the violation. While $20,000 may seem modest in comparison to larger…