Health Companies Tailor Care to Maximize Reimbursements

The Wall Street Journal reported today that three of the nation’s largest home-health companies tailored the care they provided to Medicare patients to maximize their reimbursements.

Until 2008 Medicare reimbursed home-health care services were determined in part on the number of therapy visits administered, with an extra fee (read bonus) kicking in at 10 visits. According to Medicare, the system was designed to ensure providers didn’t skimp on therapy visits.

After sensing the specter of abuse Medicare adjusted the system by offering smaller bonuses at thresholds of 6, 14, and 20 visits. This had a dramatic effect on patient visits by the three largest providers.

  • 6 visits: up 19%
  • 10 visits: down 43%
  • 14 visits: up 42%
  • 20 visits: up 30%

–Centers for Medicare and Medicaid Services

This is another example of a broken system. Corporations are mandated to provide profit to shareholders. Proper care is secondary. COP’s and guardians can’t expect to have their jobs done for them by these agencies. It’s imperative that the quality and quantity of these services be monitored regularly through client visits and vendor audits to ensure that the people we protect are getting what they need and our nation’s entitlement programs aren’t being abused.

Read the full article here

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