Medicare

In response to a congressional request, GAO investigated allegations against ABC Home Health Care, a home health agency (HHA), and its participation in the Medicare home health care program. In the Medicare program, providers may receive reimbursement only for those expenses that are reasonable in amount and related to patient care for eligible patients. Current and former employees told GAO that local ABC officer managers directed them to alter records to make it appear that patients continued to need home health visits. Additionally, managers directed employees to continue visiting patients who, in the employees' opinion, did not qualify for home health care because they no longer met Medicare rules defining homebound status. ABC also reportedly charged Medicare for the cost of acquiring other HHAs by paying owners a small sum up front and the balance in the form of salary under employment agreements, a practice that is inconsistent with Medicare regulations for reimbursement. Finally, according to former employees, some managers directed employees to market ABC and its services with the intent of charging Medicare for costs that is not reimbursable. GAO has shared information concerning possible illegal activities with appropriate law enforcement authorities. GAO summarized this report in testimony before Congress; see: Medicare: Allegations Against ABC Home Health Care, by Richard C, Stiener, Director, Office of Special Investigations, before the Subcommittee on Health and Environment and the Subcommittee on Oversight and Investigations, House Commerce Committee. GAO/T-OSI-95-18, July 19 (eight pages).

GAO found that: (1) some local office managers directed current and former employees to alter patient records so that it appeared that the patients continued to need home health visits, and to continue visiting patients that no longer qualified for Medicare home health care; (2) the firm charged Medicare for the cost of acquiring other home health agencies by paying home health owners a small sum up front, and paying the balance as a salary under employment agreements; and (3) some managers directed their employees to market the home health care firm and its services with the intent of charging Medicare for these unallowable costs.