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GOA Cites Fraud in Medicare In-Home Services Billings
By Julie Appleby,
USA Today
March 12, 2009
Fraud and abuse helped boost Medicare spending on home health services 44% over five years as some providers exaggerated patients' medical conditions and others billed for unnecessary services or care they did not provide, a Government Accountability Office report out Friday says.
The GAO reviewed home care payments from 2002 to 2006, when spending reached $13 billion. The number of Medicare enrollees using in-home services rose 17% during that period to 2.8 million.
Medicare pays for visits by nurses, aides, physical therapists and other medical professionals for homebound enrollees. They check and clean surgical wounds, give medications, provide physical therapy and assist with other skilled care.
Iowa Sen. Chuck Grassley, who is the top Republican on the Senate Finance Committee and asked for the report, says Medicare must strengthen its oversight. "Every home health care dollar that's lost to fraud or improper payments is a dollar that doesn't go to necessary care and a better quality of life for older Americans," he says. "There's no excuse for Medicare officials neglecting payment problems."
Last year, Medicare spent about $16.5 billion on home care for the services reviewed by the GAO out of a total budget of $455 billion.
The study recommends that the Centers for Medicare & Medicaid Services (CMS) consider criminal background checks on home health operators and draft new rules to remove problem providers more easily.
The growing tab for home care in some states — coupled with big jumps in the number of providers — is a concern, says William Dombi, vice president for law at the National Association for Home Care & Hospice, the industry's trade group.
"We know from our own experience that kind of growth usually indicates something is wrong," says Dombi, who has not seen the GAO report. He says the industry likely will support many of its recommendations.
Still, Dombi says not all growth is bad. "Home health care spending is less today than it was 10 years ago," he says. In 1997, Medicare spent $17.1 billion on home health care for about 3.6 million people, he says.
Then, in the late 1990s, a series of GAO reports questioned the high costs and improper payments. Dombi says spending fell to about $9 billion in 2000 and home care served about 2 million people.
"The system overreacted" to the GAO reports, he says. "There were bona fide people … entitled to home health services who couldn't find it."
The government "is committed to continually reviewing and refining our processes to improve the Medicare program," Acting CMS Administrator Charlene Frizzera wrote in response to the GAO report. She says Medicare is working to combat improper payments for home care services.
In October, the agency set new rules for home health care operators in seven states. Those include stricter background checks of equipment suppliers, unannounced visits to businesses and more scrutiny of billing records submitted by doctors.
USA TODAY reported in October that Medicare was on track to pay a projected $1.3 billion in Miami-Dade County alone in fiscal 2008 for services to homebound patients — up 1,300% since 2003.
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