Focus on Teaching Could Help Eliminate Home Health Care Fraud and Abuse

Dorian Martin Health Guide
  • Since Congress is in the early discussions of health care reform, it’s critical to look at all aspects of the health care system. Recently, two key components – Medicare and home health care – have come under scrutiny. USA Today reported that a new General Accountability Office report found that “fraud and abuse helped boost Medicare spending on home health services 44% over five years as some provides exaggerated patients’ medical conditions and others billed for unnecessary services or care they did not provide.” In comparison, the report, which analyzed home health care payments from 2002-2006, found that the number of people enrolled in Medicare who were using in-home services rose by 17% (to 2.8 million). The top five states where Medicare spending has increased are Texas (144%), Florida (90%), Nevada (88%), Oklahoma (65%), and Illinois (62%). In-home services covered by Medicare include visits and assistance provided by nurses, aides, physical therapists and other medical professionals.

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    The U.S. Department of Health and Human Services (DoHHS) shared the following information on a special Medicare website:

    “Since home health care is part-time and usually temporary, patients (and their informal caregivers) need to learn how to identify and care for possible problems, like confusion or shortness of breath. While you get home health care, home health staff teach you (and those who help you) to continue any care you may need, including medication, wound care, therapy, and managing stress. Even if a patient's health condition (such as heart failure or diabetes) is not expected to get better, patients can improve how they manage and live with their illness.”

    Furthermore, the DoHHS website notes that home health care staff should see a patient as often as ordered by the doctor. During each visit, they should:

        * Check what you are eating and drinking
        * Check your blood pressure, temperature, heart rate, and breathing
        * Check that you are taking your medicines and treatments correctly
        * Check your safety in the home
        * Teach you about your care so you can take care of yourself
        * Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who provides care to you.

    My initial feelings on this information is that, based on the GAO report, many health care providers are neglecting the “teaching” portion of their jobs. Instead, it is often easier to do it yourself than to teach someone else (the patient or the caregiver) how to perform certain tasks. Perhaps as part of an overall evaluation, each home health care provider should be evaluated on how well they teach the patient and the caregiver. And perhaps the structure for paying home health care providers can be structured so that there is an incentive to effectively teach the key skills that the patient and caregiver need to know. Until there’s a focus on education of the clients, I’m afraid that more stories of fraud and abuse concerning Medicare and home health care providers will be forthcoming. And that’s not going to be good for our economy, our health care system, or each individual’s ability to care for himself/herself.


Published On: March 19, 2009