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Gaming Medicare, Cheating Taxpayers
The country’s biggest home health care companies game Medicare to make money. That’s the conclusion of a bipartisan investigative report co-written by my staff at my direction and released this week.
The report examined company documents showing how managers encouraged physical and speech therapists to target the most profitable number of patient visits, even when patient need may not have required the care. In addition, therapy visit records for each company showed concentrated numbers of therapy visits at or just above the point at which Medicare issued a “bonus” payment.
The companies were explicit in their goals. One company physical therapist wrote of “several old tricks” up his “sleeve” to meet the desired therapy thresholds. Another company convened an “A-Team,” tasked with developing programs to target the most profitable Medicare therapy treatment patterns.
These findings are alarming. Home health care is one of the fastest-growing parts of Medicare and already costs $19 billion a year. Every dollar that goes to waste, fraud or abuse is a dollar that doesn’t serve a Medicare beneficiary. And every dollar stolen from Medicare is stolen from taxpayers.
Home health care is beneficial to patients, and something Medicare needs to preserve as much as possible. Having a nurse visit a diabetic patient or having a speech therapist help a stroke victim at home is generally preferable to the patient than being in a hospital. Home health care also is less expensive for Medicare than hospitalization.
None of that gives home health care companies the license to game Medicare and the taxpayers.
The federal agency that sets Medicare reimbursement policies needs to fix the broken home health care payment structure. I’m staying on the top of the agency. If it doesn’t do the job sooner rather than later, Congress will have to step in. The longer this kind of policy continues, the more Medicare’s budget balloons, and the bigger the burden on taxpayers.
October 7, 2011
The country’s biggest home health care companies game Medicare to make money. That’s the conclusion of a bipartisan investigative report co-written by my staff at my direction and released this week.
The report examined company documents showing how managers encouraged physical and speech therapists to target the most profitable number of patient visits, even when patient need may not have required the care. In addition, therapy visit records for each company showed concentrated numbers of therapy visits at or just above the point at which Medicare issued a “bonus” payment.
The companies were explicit in their goals. One company physical therapist wrote of “several old tricks” up his “sleeve” to meet the desired therapy thresholds. Another company convened an “A-Team,” tasked with developing programs to target the most profitable Medicare therapy treatment patterns.
These findings are alarming. Home health care is one of the fastest-growing parts of Medicare and already costs $19 billion a year. Every dollar that goes to waste, fraud or abuse is a dollar that doesn’t serve a Medicare beneficiary. And every dollar stolen from Medicare is stolen from taxpayers.
Home health care is beneficial to patients, and something Medicare needs to preserve as much as possible. Having a nurse visit a diabetic patient or having a speech therapist help a stroke victim at home is generally preferable to the patient than being in a hospital. Home health care also is less expensive for Medicare than hospitalization.
None of that gives home health care companies the license to game Medicare and the taxpayers.
The federal agency that sets Medicare reimbursement policies needs to fix the broken home health care payment structure. I’m staying on the top of the agency. If it doesn’t do the job sooner rather than later, Congress will have to step in. The longer this kind of policy continues, the more Medicare’s budget balloons, and the bigger the burden on taxpayers.
October 7, 2011