Three reports released last week bolster claims by federal fraudbusters that Medicare home-care providers are fertile ground for their probes.
HHS' inspector general's office released two of the reports. The General Accounting Office released the third.
Medicare spending on home health services has skyrocketed to more than $17 billion in fiscal 1996 from just $2.7 billion in fiscal 1989.
One phase of the government's fraud investigation of Columbia/HCA Healthcare Corp. centers on the company's home-care operations (July 21, p. 2).
In its first report, HHS said about one quarter of all home-care providers it audited had improperly billed Medicare during the 15 months ended March 31, 1996.
The agency's review of Medicare home health claims focused on five states: California, Florida, Illinois, New York and Texas. It was done as part of Operation Restore Trust, an antifraud project launched by HHS in 1995. It since has been expanded to other states and other types of providers.
In its second report, the agency found that in 40% of the Medicare claims submitted by home-care providers, providers were paid improperly during the same 15 months. That resulted in $2.6 billion in Medicare overpayments to home-care providers. About half the improper claims were deemed unnecessary or unreasonable; one-quarter of them were for patients who were not homebound. The remainder lacked appropriate physician orders.
The HHS reports were released at a hearing of the Senate's Special Committee on Aging. The panel's ranking Democrat, Sen. John Breaux of Louisiana, said the federal government was not doing enough to audit the home health industry. "Where you have this much money being spent, you have to spend a corresponding amount to ensure that it's being spent honestly," Breaux said.
The HHS reports found essentially the same situation in home care as the GAO found in its own review, according to a GAO official who testified at the hearing.
The GAO also reviewed Medicare's survey and certification process for home health agencies and found there were few requirements on the providers. That, along with lax oversight, opened the door to unscrupulous operators.