More than half of infusion therapy services supplied to nursing home patients from 1995 to 1998 by three providers were medically unnecessary, according to an audit by HHS' inspector general's office.
The draft report, released earlier this month by Rep. Fortney "Pete" Stark (D-Calif.), also found that the suppliers charged skilled-nursing facilities as much as 10 times the going rates for the infusion drugs, costs which were then passed on to Medicare. The three companies accounted for at least 20% of infusion therapy costs reimbursed by Medicare nationwide.
Three separate audit reports also recently released by HHS' inspector general's office identified more than $5 million in Medicare and Medicaid overpayments to home healthcare and clinical laboratory service providers in Kentucky and Puerto Rico.
The reports said Medicare overpaid Homebound Medical Care, Memphis, Tenn., by $1.9 million in 1995 and 1996 for services that weren't medically necessary and that were improperly documented. Medicare overpaid $857,208 to the Dr. Pila Foundation Home Care Program of Ponce, Puerto Rico, in fiscal 1996 for undocumented home-health services. The report also said Kentucky's Medicaid program overspent by $2.3 million its share of Medicare matching funds to providers from 1994 through 1996.