Increase in Medicare payments for house calls raises fraud concerns

Medicare has seen a significant increase in reimbursement dollars going towards physician house calls, according to USA Today. From 2006 to 2012, Medicare spending for home-visit services skyrocketed to $268 million--a 40 percent increase.

The data has some concerned that a service intended to better assist aging patients with limited mobility is now overrun with fraud, as FierceHealthPayer: AntiFraud previously reported.

According to USA Today, Michigan spends the most on home visits by far, with Medicare funds equal to 42 other states combined. "It's bad," U.S. Assistant Attorney General Leslie Caldwell said regarding the frequency of fraud within home care. "And it's just an easier thing to do in Michigan than in other states."

The article lists a handful of high-profile fraud cases currently under investigation in Michigan. One case, dating back to 2012, involved House Calls Physicians owner Hicham Elhorr, who was charged with $40 million in Medicare fraud, along with kickbacks to home health agencies.

More recently, in November, a Michigan physician pleaded guilty to a $19 million Medicare fraud scheme, according to a Department of Justice report. the physician conspired with others to submit fraudulent claims for physician home visits, along with referrals for home healthcare. The physician admitted that he paid kickbacks to recruiters to obtain Medicare beneficiaries and then falsified billing records for home visits. He also admitted to receiving kickbacks from home health agency owners in exchange for referrals.

Elsewhere, a federal jury convicted a Natick, Massachusetts man for his role in a $27 million scam by falsely submitting home health claims for patients that weren't home bound, according to the MetroWest Daily News.

There is some debate about the pros and cons of house calls, especially when comparing the industry's growing potential for fraud to the value of house calls for patients.

In a subsequent letter to the editor to USA Today, Steven Landers, president and CEO of Visiting Nurse Association Health Group in New Jersey, argued that "home care and house calls are win-win solutions to address rising Medicare costs and help over 70 million Baby Boomers successfully age in place in the comfort and dignity of their homes." Landers added that it was "misleading" to imply home visits contributed to more fraud than other areas of healthcare.

For more:
- read the USA Today article and letter to the editor 
- see the Michigan physician's plea announcement
- read the Department of Justice report
- read the MetroWest Daily News article

Related Articles:
Home care benefits drive losses and gains
Criminals, lax oversight threaten Michigan home care
Home care fraud plagues government programs
Medicare Advantage house calls: Necessary care or cash machine?
Home care, hospice fraud trends to watch

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