Preventing Abusive Medicare Billing

HEHS-95-260R: Published: Sep 5, 1995. Publicly Released: Sep 5, 1995.

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Pursuant to a congressional request, GAO discussed its recommendations for preventing abusive Medicare billing and whether the recommendations can be implemented legislatively. GAO noted that: (1) Medicare law could be amended to require the Department of Health and Human Services (HHS) to establish the requirements recommended, as well as establish a higher limit on the amount that Medicare will recognize as reasonable for therapy services; (2) expense claim limits could be set at the amount established under Medicare's part B fee schedules for therapy services; (3) establishing an upper limit would partially define billable units of service, since the procedure codes for occupational and speech therapy do not define the amount of time the codes cover; and (5) proposals have been made to require nursing homes to bill for the services provided to their residents, whether payment is sought from part A or part B fee schedules.

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