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United States Government Accountability Office reports widespread fraud and abuse in Medicare home health billing
February 2009 -
In a recent report, the Government Accountability Office (GAO) states that “Medicare spending on home health totaled $12.9 billion in 2006, up 44 percent from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization.”
The GAO’s examination found that multiple types of fraudulent activities are frequently occurring in the Medicare home health arena. Some of the most common types of fraud and abuse include upcoding (overstating the severity of a beneficiary’s condition), billing for unnecessary services/visits, kickbacks, and billing for services not rendered. For example, a CMS official told the GAO that “Miami HHAs have submitted claims for visits that were probably not provided, such as claims for visits that allegedly occurred when hurricanes were in the area.” Stakeholders told the GAO that such fraudulent activities “were difficult to prove.”
The New York Times
, referencing the GAO report, writes that “In Houston, more than 90 percent of the beneficiaries reviewed in one audit had improperly been given the most severe clinical rating.”
USA Today, reporting on the story, quotes Iowa Senator Chuck Grassley, who is the top Republican on the Senate Finance Committee and asked for the GAO report: “Every home health dollar that’s lost to fraud or improper payments is a dollar that doesn’t go to necessary care and a better quality of life for older Americans. There is no excuse for Medicare officials neglecting payment problems.”
In its concluding remarks of the report the GAO notes that, despite recent initiatives by CMS and PCS, “In the absence of greater prevention, detection, and enforcement efforts, the Medicare home health benefit will continue to be a ready target for fraud and abuse.”
Sandata’s Chairman and CEO, Bert Brodsky, responding to the NY Times editorial, states that technology is currently available to address many of the concerns raised by the GAO report. Mr. Brodsky’s letter can be viewed here.
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Santrax (r) operates under U.S. Patent Nos. 5,255,183, 5,646,839, 5,835,575, 5,949,856, and 5,963,912 which are owned by Sandata Technologies, LLC
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