Industry Leaders Called to Zero-In on Suspected Home Health Fraud

On the heels of an announcement yesterday that nearly 100 individuals have defrauded the government for $223 million in Medicare fraud, home health leaders are calling for a more targeted approach to zero-in on suspected areas within their industry.

“The government’s own data show that abusive billing practices in home health occur in isolated parts of the country where excessive Medicare utilization is taking place,” writes a statement issued by Senator John Breaux (D-LA) and Chairman Billy Tauzin of the Partnership for Quality Home Healthcare.

Because such fraud is largely taking place in a handful of counties and a states, according to the statement, Breaux and Tauzin are urging policymakers to undertake action to address issues of fraud and abuse in a “targeted manner.”

“Recognizing the critical need to prevent taxpayer dollars from entering criminal hands, the Partnership has been working for more than a year to develop targeted reforms to combat waste, fraud and abuse,” writes Tauzin.

Part of these efforts include reforms listed in the Skilled Home Health and Integrity Program Savings’ proposal, which notes beneficiary protections that prevent criminals from entering the system and payment safeguards that confirm the accuracy of filed claims.

Targeted measures could have potentially prevented the most recent fraud, a $51 million Miami-based home health scheme uncovered Wednesday, according to Breaux and Tauzin.

“As lawmakers look for federal savings, we urge them to take a hard look at how much money is being lost to fraud and abuse and address this national dilemma before asking seniors and honest providers to pay the price,” they write.

Sen. Breaux and Chairman Tauzin commended the Medicare Fraud Strike Force for rooting out the 100 individuals defrauding Medicare for $223 million.

Both look forward to working with Congressional lawmakers to advance reforms that address weaknesses in the Medicare program that leave it vulnerable to fraud, which ultimately threatens America’s seniors and the nation’s taxpayers.

Written by Jason Oliva