Officials rap home healthcare providers over fraudulent billing, abusive practices
Home healthcare, the fast-growing destination for many individuals who previously might have sought nursing home care, has been besieged by a spate of fraudulent Medicare reimbursement practices, government investigators say. Overstating a person's healthcare needs – or upcoding – is a significant problem, the government Accountability Office found.
In one example out of Houston, just 1 out of every 11 beneficiary claims was properly coded, the GAO said. Other frequent problems included payoffs for doctor referrals and billing for services that didn't take place.
Medicare spending on home healthcare rose 44% from 2002 to 2006, hitting $13 billion. Over that same span, the number of beneficiaries using home health services rose just 17% (to 2.8 million).
The Centers for Medicare & Medicaid Services said it was considering some of the GAO's recommendations, including revoking billing privileges for a broader range of claims offenders and requiring criminal background checks for employees.