MEDICARE: GAO FINDS HOME HEALTH SERVICES RAMPANT WITH FRAUD
"One out of two claims submitted to Medicare for home healthThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
care services contained charges that were inappropriate,
according to a study released yesterday by the U.S. General
Accounting Office," Boston Globe reports. The GAO report, which
was commissioned by U.S. Sen. Tom Harkin (D-IA), found 43% of 80
claims submitted in May 1995 by home health agencies in
California were inappropriate "because they were either medically
unnecessary, not covered by Medicare, not authorized by a
physician, or were never delivered."
A LOOK BACK
The GAO report found that spending on home health services
increased from $2.1 billion in 1988, to $18 billion last year.
Federal funding "to weed out billing abuses," however, decreased
from $61 million in 1989 to $33 million in 1995. "Ten years ago,
60% of home health claims were reviewed; today, just two percent
of claims undergo review," Globe reports. As a result, "it has
become 'nearly impossible to determine whether a beneficiary ...
even received the services being billed to Medicare,'" according
to the report.
Harkin said yesterday that he would introduce legislation to
combat the problem. His plan would require "frequent offenders
to pay for stepped up investigations" and would require companies
"with a relatively high incidence of billing errors to pay for a
more thorough review of their records," according to Peter
Reinecke, Harkin's legislative director. Industry groups
"declined to comment" on the report, saying that they have not
had sufficient time to review it. Eric Sokol of the National
Association for Home Care said that current Medicare reform
legislation includes penalties for companies convicted of fraud.
The bill specifically bars companies convicted three times of
criminal offenses from participating in Medicare and increases to
10 years the amount of time "in which companies with two
convictions are excluded from the program" (Pham, 6/24).