GAO Report Pinpoints HHA Fraud, Abuse

Upcoding — overstating the severity of a beneficiary’s
condition — along with kickbacks, billing for services not
rendered and other fraud and abuse contributed to a 44 percent
increase in Medicare spending on home health care services from
2002-2006, according to a Government Accountability
Office report. For example, the report said, a CMS contractor
found that only 9 percent of claims were properly coded for 670
Houston beneficiaries who had the most severe clinical rating and
who were served by potentially fraudulent HHAs.

Released Friday, the report found Medicare spending on home
health totaled $12.9 billion in 2006, up 44 percent from 2002,
despite an increase of less than 17 percent in the number of
beneficiaries using the home health benefit during the five-year
period. The report also found the number of home health agencies
increased from 6,553 in 2002 to 8,463 in 2006, with more than half
of the increase in only two states — Florida and Texas. To
strengthen the controls on improper payments, the GAO recommended
that CMS consider verifying the criminal history of all key
officials named on an HHA enrollment application and developing new
rules to make removing problem providers easier. Read the
report in its
entirety on GAO’s Web site.