Four HHAs Under Investigation for Medicare Fraud
- By admin aapc
- In Audit
- June 11, 2010
- Comments Off on Four HHAs Under Investigation for Medicare Fraud
Four of the largest home health care agencies (HHA) in the nation are reportedly being investigated by the U.S. Senate Finance Committee for suspected Medicare abuse.
Following a May 13 Wall Street Journal analysis, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) sent a letter to Amedisys Inc., Gentiva Health Service Inc., LHC Group Inc., and Almost Family asking questions about the correlation between the number of home health therapy visits they provided and the Medicare reimbursement rate for those visits.
According to the Journal’s analysis, after Medicare rates increased in 2008 for patients receiving more than nine visits, the number of Amedisys patients who received 10 visits was three times the number of patients who received nine visits. When the basis for Medicare payments shifted to 6, 14 ,or 20 visits, Amedisys patients getting 10 visits dropped by 50 percent, patients getting 14 visits rose 33 percent, and patients getting 20 visits increased 41 percent, according to the analysis.
“So far, it appears that either the home health care reimbursement policy is flawed, some companies are gaming the system, or both,” said Grassley. “As the Senate committee of jurisdiction, we’re working to figure out what’s going on.”
Sens. Baucus and Grassley also questioned the companies regarding their promotional material, which they say appears to unfairly target Medicare patients.
“Companies that work with Medicare should not be allowed to target seniors just because they have Medicare or adjust the way they care for patients simply to increase profits,” Baucus said. Baucus said he intends to closely review the practices of these and all companies working with the Medicare program.
The full text of the Senators’ letters to the agencies is available on the United States Senate Committee on Finance website, in the Related Files section.
Source: Reuters, The United States Senate Committee on Finance, The Wall Street Journal
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I have been involved with Medicare-based home health care for 20 years. The fraud and abuse is rampant. As of this year, Medicare is putting into place several mechanisms to cut through the fraud and abuse. What many people perceive as Medicare insolvency is related to the terrible loss of funds as a result of fraud and abuse; recoupment of these funds will surely help Medicare remain solvent. It should be noted that there is a full array of patterns of Medicare fraud and abuse, not just overutilization of therapy services.
I have seen the abuse in our town for years. I do not understand how our govt. has let so many things go unmonitered. It isn’t just medicare, it is the way our entire system is run. I absolutely do not understand. PERIOD.