NCJ Number
80555
Date Published
1981
Length
54 pages
Annotation
Findings and recommendations regarding home health care fraud and abuse are presented in this report from the U.S. Senate Committee on Governmental Affairs.
Abstract
The primary focus of this review was a group of nonprofit, tax-exempt home health agencies and their subcontractors operating in the Chicago metropolitan area. As a result of the investigation, made concomitantly with case studies by various organizations in other States, the medicare home health program was found to be highly vulnerable to fraud, waste, and abuse, providing an almost open-ended opportunity for unscrupulous operators to profit substantially. Particularly, it was found that the current retrospective cost reimbursement system, as it applies to nonprofit agencies, lends itself to fraud, waste, and abuse. It provides no incentive for home health agencies to contain costs and offers no viable mechanism by which the Government can recoup overpayments. Generally, intermediaries were found to fail in timely notification of home health agencies of changes in regulations. Further, patients tend to be ill-informed about their options or entitlements under the home health care programs. The Health Care Finance Administration is judged to have failed to make adequate use of its authority to terminate home health agencies or otherwise preclude persons from participation in the home health care program. Intermediary audits were found to provide the best first line of defense against excessive and inflated costs. Recommendations derived from the findings are presented. A Better Government Association report on home health care and other in-home services is appended. A total of 165 footnotes are provided.