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Highlights

As of June 1978, there were 2,612 agencies certified by Medicare to provide home health care. A detailed audit was conducted at 11 home health agencies to verify that the costs claimed for Medicare were in fact incurred, allowable, reasonable, and properly reported. This review focused on proprietary and private nonprofit agencies.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health, Education, and Welfare (HEW) should direct the Administrator of the Health Care Financing Administration (HCFA) to develop the cost limits under Section 223 of the Social Security Amendments of 1972 for individual home health care cost elements where this is appropriate.
Closed - Not Implemented
HCFA is developing a prospective payment system for home health services and is considering limiting individual cost elements under it. The agency thus does not plan to revise section 223 limits.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to emphasize to providers that costs claimed under Medicare must be documented.
Closed - Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to require intermediaries to routinely test, on a sample basis, provider adherence to the documentation requirements.
Closed - Not Implemented
Because of its plans to propose a prospective payment system, the agency does not intend to act.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to emphasize to home health providers that prior approval is required for those fringe benefits not otherwise specifically authorized.
Closed - Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to require that home health agencies provide specific reporting on the salaries and fringe benefits furnished to individual employees.
Closed - Not Implemented
The Office of Management and Budget refused to allow HCFA to collect the data necessary to implement this recommendation.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to clarify and strengthen program instructions for the specific types of promotional activities that are allowable, and require providers to document the scope and nature of the duties of agency employees often designated as discharge planners or hospital coordinators.
Closed - Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Health and Human Services The Secretary, HEW, should direct the Administrator, HCFA, to require prior intermediary approval of home health agency contracts whose costs exceed a specified amount and/or whose term exceeds a specified period of time.
Closed - Not Implemented
The report disclosed abusive contracting practices but recent legislative changes have made the recommendation moot. The Reconciliation Act of 1980 gives the Secretary of HHS access to the books of subcontractors who supply providers goods and services over $10,000 in a 12-month period. Also, Medicare reimbursement to home health agencies for contracts based on percentage are now prohibited.

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