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GAO: Upcoding, abuse common in home health

Medicare is dogged by coding errors and other fraudulent and abusive practices in the home health arena, according to a new report from the Government Accountability Office. Detecting such problems is critical given the growth of home health spending, which has gone up 44 percent from 2002 to 2006 to almost $13 billion.

One major problem found by the GAO was upcoding, the practice of overstating the seriousness of a beneficiary's condition in an effort to get paid more. For example, one CMS contractor found that only 9 percent of home health claims were coded properly for 670 beneficiaries in Houston with the most severe clinical rating.

The GAO also noted that the HHS Office of the Inspector General had detected a range of fraudulent and abusive billing practices among home health providers, including payments to physicians for referrals and billing for services not rendered.

To get more information from the GAO report:
- read this Modern Healthcare article (reg. req.)

Related Articles:
CMS fights home health fraud
Medicare plans home health P4P program

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Comments

Is this a surprise? I have been in the Home Health business for over 20 years, although there is abuse in any system, overall this is a sound way to care for patients. The cost for 30 days of care in the home is equal to one days cost in the hospital. It makes no sense for Congress to NOT support this industry, and they do not and turn a deaf ear to these savings and peoples wishes to be care for in the home. It really is incredible that home care can do almost anything in the home outside of intensive care. Are there bad rats, you bet, but, are there bad rats in hospitals, you bet. So, where had you rather spend less on those Rats? Home of course. Do your homework folks and find out that our country needs to support home care to the inth degree. But your dumb Congressman and Women are either bought off or just don't care.

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