Probers: Medicare Fraud Is Widespread

By Goldreich, Samuel | The Washington Times (Washington, DC), July 29, 1997 | Go to article overview

Probers: Medicare Fraud Is Widespread


Goldreich, Samuel, The Washington Times (Washington, DC)


Federal investigators said yesterday as many as 40 percent of Medicare home health care payments should not be made but have escaped the scrutiny of officials responsible for overseeing claims.

"This program is out of control," George Grob, deputy inspector general for the Department of Health and Human Services (DHHS), said during a Senate hearing on how to fight billions of dollars of fraud and abuse in the Medicare program.

Poor oversight of Medicare has contributed to soaring home health expenses, which have jumped to more than $18 billion this year, up from $3.5 billion in 1990, he said. Overpayments cost Medicare between $2.1 billion and $3.1 billion in California, Texas, New York and Illinois alone, according to an audit of $6.7 billion in claims over 15 months ending in March 1996, according to an inspector general's report released yesterday.

In a second study that also included Florida, the inspector general reported that 25 percent of home health agencies have defrauded the Medicare or Medicaid program.

"Home health care is a good investment for taxpayers if the money is spent wisely," said committee Chairman Sen. Charles Grassley, Iowa Republican. "But it's a situation where a few bad apples can spoil things for everyone."

Home health care is intended to save money by keeping people out of more expensive hospitals and nursing homes. But it has become a special focus of budget-cutters and fraud-busters, as home care has grown to about 9 percent of the $200 billion Medicare program.

Coming on the heels of an inspector general report last month that estimated that Medicare overpays as much as $23 billion for all benefits each year, the new studies have sparked calls for a serious crackdown on the program.

The General Accounting Office also told the Senate panel yesterday that home health agencies are certified under Medicare even if they don't meet federal health and safety standards. Even those that are cited for violations can avoid expulsion simply by filing "corrective action plans."

Fewer than 0.3 percent of all agencies ever lose certification, said GAO auditor Leslie Aronovitz.

But Congress is about to pass a Medicare package that will yield only about $3 billion in fraud and abuse savings, according to the Congressional Budget Office.

Mr. Grassley urged creation of a federal strike force to go after home health agencies that claim unusually high rates of visits. …

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