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GAO reports fraud within Medicare home health service billings

GAO reports fraud within Medicare home health service billings

The GAO, also known as Government Accountability Office has conducted a study on Medicare spending for home health care services offered to the patients. Upon the completion of the study, they found that most of the home health care service providers submit false and exaggerated billing summary in order to avail more payment from Medicare. This has led to a serious confusion as it consumes most of the funds of Medicare. But the providers also oppose such statements by showing accounts. This article reports the story in details.

On March 13, 2009, the Government Accountability Office, commonly known as GAO, has released a report, which reveals that fraud and monetary exploitation assisted 44% increase in the Medicare payments for in-home services for the past 5 years. This happened because few of the providers has embellished their patient's health conditions and also overstated few needless services, which were in fact not provided to the patients.

The compensation for home health services made by Medicare in between the year 2002 and 2006 were inspected by GAO. During this time the Medicare spending attained a sum of $13 billion. Above 2.8 billion Medicare patients were found to use the home health services at that time.

When patients avail in-home services, their health checkups and services are carried on by nurses, health care assistants, therapy specialists, clinical professionals etc. Their job is to look after the patient, prescribing drugs, offering required medical services and therapies. The entire expenses incurred are billed to Medicare, who compensates the costs.

But after this fraudulent case was reported by GAO, Medicare was instructed by Iowa Senator, Chuck Grassley to reinforce its inspection before making such spending. Grassley believes that this is one of the main reasons for the loss of funds and delay in health care delivery for the needy people.

In the year 2008, Medicare spending for home health services was around $16.5 billion. The GAO research suggests the CMS (Centers for Medicare & Medicaid Services) to conduct criminal investigations on in-home service providers and file charges on those found guilty. However, as per GAO, such crisis can be eradicated only if strict rules are formulated regarding this issue.

The Vice President for Law at National Association for Home Care & Hospice, William Dombi, has also accepted such accusations although he has not personally viewed the reports of GAO. However, he has not accepted that all the home health service providers make such exaggerations in order to get more amount of money from Medicare. When he was questioned about the rise in Medicare spending, Dombi claimed that the rise in spending is not so much. To support his statement he pointed out that in the year 1997, Medicare paid a sum of $17.1 billion for in-home care services for nearly 3.6 million patients. Again, in the year 2000, Medicare paid around $9 billion for nearly 2 million of its customers. So considering the rate of Medicare spending for the particular number of patients, the current growth in spending is more or less justified as per Dombi.

In reply to the reports of GAO, the current Administrator of CMS, Charlene Frizzera has remarked that efforts are bring made by the Government for the development of Medicare. Even, Medicare itself is now on the process of fighting against fraudulent billings for in-home care services.

The agency formulated new regulations for in-home care service providers in 7 states of the country on October 2008. These rules comprises stringent investigations of equipment providers, surprise visits to the workplaces of home health care providers and further analysis of billing reports tendered by the physicians.

On October 2008, USA Today aired that Medicare was heading forward to spend in the Miami-Dade County; an estimated sum of $1.3 billion in the financial year of 2008, for home health care services meant for the homebound patients.

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