Medicare:

Improper Activities by Mid-Delta Home Health

T-OSI-98-6: Published: Mar 19, 1998. Publicly Released: Mar 19, 1998.

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Eljay B. Bowron
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contact@gao.gov

 

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Pursuant to a congressional request, GAO discussed the results of its investigation into allegations of improper Medicare billings by Mid-Delta Home Health.

GAO noted that: (1) under the Medicare program, home health care providers are reimbursed for their reasonable costs of servicing beneficiaries; (2) costs submitted for reimbursement must be necessary, proper, actual, and related to patient care; (3) however, in GAO's opinion, Mid-Delta Home Health improperly claimed, and was reimbursed for, certain payroll costs that it had not incurred; (4) these costs included unused leave payments and bonuses that the employees had been asked to return to Mid-Delta and the full-time salary paid to the owner's daughter while she attended nursing school in 1996; (5) GAO also questioned the propriety of certain other costs that Mid-Delta claimed for Medicare reimbursement; and (6) these questionable costs included: (a) large bonuses given to the owner's daughter that amounted to 119 percent of her salary; (b) community education costs that were primarily related to marketing and not patient care; (c) a $10,000 bonus used to help purchase a business and then claimed to Medicare as a payroll cost; and (d) claims for apparently unneeded Mid-Delta visits to a number of patients and for visits to other patients whose eligibility for homebound status was questionable.

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