Medicare Proposes Cap On Home Health Care Agency Payments

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).

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