Home Health Care Fraud

DADE COUNTY: THE HOME HEALTH CARE FRAUD CAPITOL OF THE NATION

The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.

What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.

Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.