A recent Office of Inspector General (OIG) audit highlights an important reminder for nursing homes and other healthcare providers: Medicare billing and documentation remain under close scrutiny. Even when a Medicare Administrative Contractor (MAC) has reviewed and allowed a claim, that does not necessarily mean the claim would withstand a broader audit.
On July 20, 2026, the OIG released an audit of Medicare Part B services provided to skilled nursing facility (SNF) residents. The audit reviewed claims allowed by Novitas Solutions and estimated approximately $19.5 million in improper payments. Although the audit focused on Novitas’ review process, the findings should get the attention of any organization providing or billing for Medicare Part A or Part B services in a SNF setting.
The key takeaway is simple: a claim may look correct on the surface, but a comprehensive review of the full medical record can reveal documentation, medical necessity, coding, or billing concerns that were not identified during a narrower claims review.
What LWCI Is Seeing
At LW Consulting, Inc. (LWCI), our Part A and Part B audit work has identified similar concerns. These findings show that compliance risks are not limited to government reviews or MAC claim sampling. When the full resident record is reviewed, issues often appear in the documentation, coding, diagnoses, and clinical support needed to justify Medicare coverage and payment.
Our latest whitepaper, When Medicare Documentation Falls Short: Why Healthcare Organizations Should Consider External Audits, explores these risks and explains how independent audits can help organizations identify recurring documentation issues, strengthen compliance, and reduce the risk of denials and repayments.
Get the Whitepaper
Is your organization confident that its Medicare documentation would withstand a comprehensive audit? Download our latest whitepaper to learn how an independent external audit can help identify gaps, uncover trends, and support practical improvements across clinical and billing processes.
Get the whitepaper to learn more about Medicare compliance and the value of an independent external audit.
LW Consulting, Inc. (LWCI) offers a comprehensive range of services to assist your organization in maintaining compliance, identifying trends, providing education and training,  or conducting documentation and coding audits. For more information, contact LWCI to connect with one of our experts!
