GAO: Upcoding, abuse common in home health

Medicare is dogged by coding errors and other fraudulent and abusive practices in the home health arena, according to a new report from the Government Accountability Office. Detecting such problems is critical given the growth of home health spending, which has gone up 44 percent from 2002 to 2006 to almost $13 billion.

One major problem found by the GAO was upcoding, the practice of overstating the seriousness of a beneficiary's condition in an effort to get paid more. For example, one CMS contractor found that only 9 percent of home health claims were coded properly for 670 beneficiaries in Houston with the most severe clinical rating.

The GAO also noted that the HHS Office of the Inspector General had detected a range of fraudulent and abusive billing practices among home health providers, including payments to physicians for referrals and billing for services not rendered.

To get more information from the GAO report:
- read this Modern Healthcare article (reg. req.)

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