For the third time since 1980, a General Accounting Office study has found that controls over Medicare's home health program "remain essentially nonexistent."
One effect of the lack of controls has been a huge increase in Medicare home health spending, the GAO, Congress' investigative arm, reported. In 1989, 1.7 million Medicare beneficiaries accounted for $2.7 billion in Medicare costs. By 1994 that number had increased to 3 million beneficiaries and nearly $13 billion in spending. The GAO estimated that by 2000, Medicare home health spending will exceed $21 billion.
Most of the growth has come from proprietary home health firms rather than not-for-profits, the GAO reported.
"(Federal officials) believe that because the beneficiary incurs no cost and little data exist on the effectiveness of different plans of care, (home health agencies) primarily compete by offering greater numbers of services to beneficiaries," the report said.
Even though costs have skyrocketed, less than 1% of all Medicare-certified home health agencies were audited in 1994, according to the GAO study.
"Few home health claims are subject to medical review, and most claims are paid without question," the GAO said.
HCFA has created an internal task force to study the problem and has issued a draft revision of conditions for participation in the Medicare home health program. The GAO said the HCFA initiative should help but will not solve the major problems.