Q&A: Is it ethical to have a Medicare Part A resident purchase and supply her own medications while on a skilled stay?

Rena R. Shephard, MHA, RN, RAC-MT, DNS-CT, QCP-MT

Question:  While reviewing physician orders from last night, I found one order that states "have family provide EC Acetaminophen."  The resident is in our SNF for a Medicare Part A stay.  It’s my understanding that all of her medications are covered under Part A?  Is it really ethical to have the patient purchase and supply his/her own medication while under a Medicare beneficiary?

Answer: It is not just an ethical problem, it is a legal problem. The RUG per diem payment the facility receives includes payment for the resident's medications. Allowing the resident to bring in the medication and as a result allowing the resident (or anyone else) to pay for it is viewed as Medicare fraud or abuse. For more information, go to CMS.gov and enter "SNF consolidated billing" in the search field.

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