Boosts In Medicare Spending Due to Fraud, Report Says
March 23, 2009
USA Today on March 12, 2009, released the details of a Government Accountability Office report. According to the report, from 2002 to 2006, Medicare spending on home health services marked a 44% increase due in large part to fraudulent action by providers, including exaggerated patient medical conditions and billing Medicare for unnecessary services or care that was not provided. The 44% spending boost coincides with a mere 17% rise in Medicare enrollees during the same time period, for a total of $13 billion in spending for 2.8 million enrollees in 2006.
The home health services provided for by Medicare include visits by nurses, aides, physical therapists, and other medical professionals who monitor and treat surgical wounds, deliver medications, provide therapy and assist with other skilled care. In 2007, $16.5 billion of Medicare’s $455 billion budget was devoted to home care.
William Dombi, vice president for law at the National Association for Home Care & Hospice (the industry’s trade group), said the boost in spending combined with an increase in providers is a concern.
“We know from our own experience that kind of growth usually indicates something is wrong,” says Dombi. He says the industry is likely to back many of the GAO report’s recommendations.
The report suggests that the Centers for Medicare & Medicaid Servicse (CMS) consider criminal background checks on home health operators and draft new rules to ease the process of removing ‘problem providers’.
The government “is committed to continually reviewing and refining our processes to improve the Medicare program,” Acting CMS Administrator Charlene Frizzera wrote in response to the GAO report. She says Medicare is working to combat improper payments for home care services.
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