Medicare Halves Payments Wrongly Made to Home-Health Agencies
According to a report issued by Inspector General June Gibbs Brown of the Health and Human Services, Medicare has sharply reduced the amount of improper payments made to home health agencies. The audit of home-health agencies in California, Illinois, New York and Texas showed the improper payment level to be almost 19%. An earlier audit done in 1997 showed the figure to be almost 40%. Although this certainly represented a big step forward there still is much more room for improvement in this area.
Auditors considered the payment improper if the services weren't reasonable and necessary; the beneficiaries weren't homebound; or the services weren't rendered with a valid doctor's order. It was determined that there were cases where doctors didn't realize that only patients who were homebound qualified for home care.
In another study done about improper Medicare payments the auditors determined that about 7% of the payments were improper.
The Inspector General recommended that Medicare require physicians to examine patients before ordering home-health services and to see the patients at least once every 60days to assess their condition. She also stated that the new higher payments rates scheduled to go into effect at the beginning of 2000 were "inflated" due to improper calculations. The study covered all home-health care payments made by Medicare in the 4 states for the first 9 months in 1998. It concluded that "unallowable or questionable claims" totaling $675.4 million were paid out for claims totaling $2.3 billion over the 9 month period of time.
In a second report issued in conjunction with this report it was determined through interviews with hospital discharge planners that about 85% of them reported that patients were able to obtain home care when they needed it.
The HCFA stated that it was pleased to see the reduction that has taken place in improper payments, but acknowledged that there is still a great deal of work to be done.
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December 2, 1999
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