Coding errors and other fraudulent and abusive practices are contributing to improper Medicare payments in home health, the Government Accountability Office reported. Upcodingthe practice of overstating the severity of a beneficiarys conditionby home health agencies was one of the major contributors to Medicare home health spending and utilization, according to a GAO report. As an example, a CMS contractor found that only 9% of claims were properly coded for 670 beneficiaries in Houston who had severe clinical ratings and were served by potentially fraudulent home health agencies. A review of court cases and actions taken by HHS inspector generals office revealed other fraudulent and abusive practices that contributed to spending and utilization, such as payments to physicians for referrals, and billing for services not rendered. Medicare spending on home health totaled nearly $13 billion in 2006, up 44% from 2002, the GAO reported. Inadequate administration of the Medicare home health benefit leaves the benefit vulnerable to improper payments, the GAO reported. The CMS said that it would consider several of the GAOs recommendations, such as amending regulations to expand the types of improper billing practices that warrant revocation of billing privileges. President Barack Obama recently recommended that home health Medicare reimbursements be cut by $37 billion over 10 years, a move strongly opposed by home health providers (March 9, p. 18).
Late News: GAO: Coding errors, fraud, abuse cause Medicare payment probs
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