DATE: Sunday, August 17, 1997               TAG: 9708150036

SECTION: COMMENTARY              PAGE: J4   EDITION: FINAL 

TYPE: Editorial

                                            LENGTH:   48 lines

HOME HEALTH CARE REFORM NEEDED NOW

The funding of home health care by Medicare has been a blessing for many seniors. But rampant fraud and abuse threaten to make the program the bane of taxpayers. It is in urgent need of reform.

Investigators took a look recently at five states with large Medicare populations - Florida, Texas, California, Illinois and New York. They concluded that 25 percent of home-health-care companies doing business with Medicare could be classified as ``problem providers.''

The new tax and budget agreement made some obvious fixes. Felons will henceforth be banned from providing services, and a much-abused policy of paying providers before services had actually been rendered has been eliminated.

But plenty of flaws remain, most related to inadequate oversight and to weak-kneed punishment. Only 2 percent of bills are actually scrutinized, so the odds that con men will be caught are not great. Yet in one test, 43 percent of claims were found to be bogus or unjustified. Part of the blame for that belongs to difficult-to-decipher government rules, but a lot goes to outright abuse.

In some ways, the system invites the abuse. Social Security and tax numbers are not routinely checked, so when crooked providers are caught they can set up in business again under a new name without causing alarm bells to go off. Even when perpetrators are caught and fined or ordered to repay disallowed claims, they are able to escape by declaring bankruptcy. Often, a new company springs up under the same management to begin practicing the same scams all over again. These include overbilling, billing for services never rendered and billing for additional services never authorized.

To list the flaws in the system is to suggest the reforms needed. A lot more oversight is clearly in order, to catch those abusing home health care. And loopholes must be closed to assure that punishment is actually delivered. Finally, once a provider is caught in the act, there should be no second chances. Providing medical services to Medicare recipients is not a right, it's a privilege. Those who abuse the trust should not be allowed to do so again.

Billions are at stake, along with the health of senior citizens. It is essential that Congress give administrators the tools needed to get tough on abusers who bring a worthy program into disrepute. Taxpayers want and deserve some assurance that the money being spent on home health care - $16.9 billion in 1996 - isn't being misspent. Streamlined rules, more personnel devoted to monitoring and penalties with teeth would help.

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