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February 2006
 OIG Review of Nursing Facility Resource Utilization Groups The Office of the Inspector General (OIG) found that 26% of claims submitted by skilled nursing facilities in 2002 had a different Resource Utilization Group
(RUG) than one reviewers generated based on evidence from the rest of the medical record. These differences represent a net $542 million in potential Medicare overpayments for fiscal year 2002.
OIG reviewers inspected medical records for 272 skilled nursing facility claims. When reviewers found an inconsistent RUG assignment, they recoded the entire medical record with the new RUG to calculate the net difference.
OIG presented these findings to the Centers for Medicare and Medicaid Services (CMS). CMS agreed with OIGs assessment and impact of the incorrect RUG assignments
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