LTACH Fraud
this often violated rule applies when a Medicare inpatient is discharged from a long-term care hospital (LTCH) to an acute care hospital, IRF (Inpatient Rehab Facility), SNF (Skilled Nursing Facility), or the patient’s home and then readmitted to the same long-term care hospital within 3 calendar days of the original discharge from the long-term care hospital. The 3-day or less period begins with the date of discharge from the long-term care hospital and ends not later than midnight of the third day. Medicare considers an “interrupted stay” to be part of the first LTCH admission (or a single discharge from the LTCH). Further, Medicare will only make a single LTCH PPS payment for an interrupted patient stay. This rule is designed to avoid provider attempts to gain payment for 2 admissions and discharges in a short period of time. Medicaid administers the Medicaid program through the state, and receives federal funds for the provision of healthcare to the states’ residents, and also for recovery of funds stolen through fraud and abuse.