Medicare Proposes Cap On Home Health Care Agency Payments

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The Miami Herald reports: "Fueled by massive fraud, home healthcare providers in Miami-Dade County are raking in more Medicare money than their colleagues in the rest of the country combined -- thanks to bogus billings for patients with diabetes, authorities say. Now, Medicare is taking tough steps to stop agencies from filing hundreds of millions of dollars a year in false claims." A federal agency is proposing "a nationwide cap that would reduce Medicare reimbursements to any agency treating homebound patients with diabetes or other chronic ailments. The proposed limit: 10 percent of the bill. Though national in scope, Medicare's plan is really aimed at shutting down hundreds of home healthcare agencies in Miami-Dade suspected of submitting phony claims for twice-daily insulin injections by a visiting nurse, officials said."

The Herald reports that the proposal to cap the payments "for costly homebound patients could save the entitlement program for the elderly an estimated $340 million a year -- money that could help pay for other healthcare services. If adopted, the cap would take effect in January" (Weaver, 8/4).

Meanwhile, The Plain Dealer gives consumer advice on Medicare's discharge procedures including those regarding home health care: "If you think you're too sick to leave [a hospital], you can ask Medicare to review your case. And while that review is under way -- it usually takes a day or two -- Medicare will continue to pay for your stay. The rule doesn't just apply to hospitals. It's true for nursing-home and rehabilitation-center stays and home health care, too. And requesting a review is simple" (Suchetka, 8/4).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

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