HFMA – March 16, 2009.

Medicare spending on home health care–typically following a hospital discharge or for treatment of a chronic condition–totaled $12.9 billion in 2006, up 44 percent from 2002, according to a new report from the Government Accountability Office (GAO).  Click title to read more…

The GAO found that upcoding–overstating the severity of a beneficiary’s condition–by home health agencies (HHA) and other fraudulent and abusive practices contributed to Medicare home health spending and utilization. Court cases and Department of Health and Human Services Office of Inspector General actions illustrated that kickbacks and billing for services not rendered also contributed to Medicare spending and utilization.

The report concludes that inadequate administration of the Medicare home health benefit leaves the benefit vulnerable to improper payments. The GAO found that the Centers for Medicare & Medicaid Services (CMS) does not require its contractors to verify the criminal history of persons named on applications from prospective HHAs. It also does not generally include physicians, who are in a position to detect certain types of improper billing, in the agency’s efforts to detect improper payments. The GAO found that CMS has not addressed the removal of HHAs or HHA officials from Medicare for certain types of abusive or improper billing.

Read the report.