ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Monday, March 10, 1997 TAG: 9703100098
SECTION: EDITORIAL PAGE: A-6 EDITION: METRO
Inadequate oversight of Medicare-funded home health care invites the kind of fraud and abuse that could eventually kill what should be a valuable program.
PUSHED OUT of hospitals almost as soon as the anesthesia from surgery wears off, or sent home from the doctor's office with a diagnosis that requires regular injections or therapy, many elderly citizens, especially those living alone, desperately need home health-care services.
Unwittingly, these patients can become cash cows for unscrupulous operators of for-profit home-health agencies taking advantage of the lax-to-nonexistent controls in the portion of Medicare that pays for home visits by care providers. Without adequate oversight, the home-health program invites fraud and abuse - abuse that by one estimate represents a fourth of the program's $18 billion-a-year cost.
Somebody must get a handle on it. If not, the program may not be around when you or your elderly relative needs it.
While the home-health industry argues that fraud and abuse are not significant problems, evidence mounts to the contrary.
One Florida company billed Medicare $26 million for home-health visits never made, or for visits to people who weren't homebound or whose doctors had not authorized home treatments.
Even if doctors authorize visits, they often don't keep check (as they're supposed to) to see if the visits should continue. No one, in fact, keeps check. This allows some home-health agencies, at up to $90 per visit, to extend services long past the time they're medically justified.
Since none of the cost comes directly from elderly clients' pockets, they seldom complain. Sadly, many are lonely, rarely ever visited by relatives, and are pleased to have a health-care worker frequently drop in just to say hello.
Many home-health agencies are ethical and deliver cost-effective services. But increased demand, spurred by an aging population and changes in the health-care system, has fueled a growth industry that is also attracting the not-so-ethical. Some have tried to bilk Medicare for lease payments on BMWs, disguised as ``administrative overhead.''
Government deregulation can be a worthwhile effort, but it shouldn't be confused with utter abdication of oversight responsibility - particularly when taxpayers' money is involved. Home health care was intended to save money by keeping Medicare recipients out of hospitals and nursing homes. But virtually unregulated, its costs have soared, by more than 500 percent since 1990.
Efforts to keep Medicare solvent must include more accountability for home health care. The program is too valuable to fall victim to waste.
LENGTH: Medium: 52 linesby CNB