Medicare: Allegations Against ABC Home Health Care

GAO discussed specific allegations regarding a home health care firm's participation in the Medicare home health care program, focusing on whether its employees submitted fraudulent claims to Medicare for patient-related services. GAO noted that: (1) some local office managers directed current and former employees to alter patient records so that it appeared that the patients continued to need home health visits and to continue visiting patients that no longer qualified for Medicare home health care; (2) the firm charged Medicare for the cost of acquiring other home health agencies by paying home health owners up front and paying salaries under employment agreements; (3) some managers directed employees to charge Medicare for these nonallowable costs; (4) certain employees solicited patient referrals from physicians, gave gifts and other items of value in return for patient referrals, and then charged Medicare for these expenses; and (5) in February 1995, the Department of Health and Human Services excluded the firm from participation in the Medicare program for 7 years.