Medicare: Need to Hold Home Health Agencies More Accountable for Inappropriate Billings
HEHS-97-108
Published: Jun 13, 1997. Publicly Released: Jun 23, 1997.
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Highlights
Pursuant to a congressional request, GAO reviewed Medicare's ability to detect and prevent inappropriate payments to home health agencies, focusing on: (1) the weaknesses of existing Medicare controls over the home health benefit; (2) lessons learned from examining private insurers' controls over home health payments and recent federal antifraud initiatives; and (3) a management approach that could improve Medicare's ability to avoid substantial payments attributable to abusive billing practices.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| To hold home health agencies more directly accountable for billing Medicare appropriately, the Congress may wish to consider enacting legislation directing HCFA to carry out a pilot demonstration to address the issue of abusive billing practices by home health agencies. Under such a demonstration, once improper billing has been detected that identifies an agency as an abusive biller, follow-up audit work would be conducted and the cost of this follow-up work would be assessed against the home health agency. | The appropriation and authorization committees are not considering the imposition of audit user fees and there is no current HHS budget proposal for FY 2000 for audit user fees. | |
| To make such claims audits financially feasible, the Congress may wish to earmark monies from the assessed audit costs for HCFA's payment safeguard activities. | The appropriation and authorization committess are not considering the imposition of audit user fees at this time and there is no current HHS budget proposal for FY 2000 for audit user fees. |
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Topics
Claims processingErroneous paymentsFraudHealth care programsHome health care servicesInternal controlsMedical expense claimsMedicareMonitoringProgram abusesHealth insurance portabilityQuestionable billing