Review of Complaints Which Caused Three Nursing Homes to Withdraw from the Medicare Program

HRD-77-137: Published: Sep 9, 1977. Publicly Released: Sep 9, 1977.

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Complaints made by three nursing homes in South Carolina involved many of the same issues which have caused other nursing homes to withdraw from the Medicare program in the past. The most important criticism of the program is that Medicare's payment of services already provided may be denied if the intermediary determines that the services were not medically necessary. This problem can only be eliminated by liberalizing Medicare's law and regulations.

The Honorage Nursing Center and the Commander Nursing Home in Florence, South Carolina, and the Hampton Nursing Center in Sumter, South Carolina, all complained of the large amount of paperwork required by the Medicare program. A cursory review of the forms and documents required showed the paperwork to be voluminous and frequent, but necessary to control of the program. The nursing homes also complained that the Medicare guidelines do not allow for adequate compensation of the owner-administrator of the homes. The amount of money not allowed due to limitations on compensating the owner-administrator does not seem significant, since the administrator's salaries are a small part of the nursing homes' total cost. All three of the homes complained of the uncertainty of the intermediary's decisions with regard to the necessity of the medical services and the level of care provided and of the possible financial losses which could result from losing their waivers of liability.

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