Medicare Home Health Agencies

Becoming a Medicare-certified home health agency is relatively easy--probably too easy, given the large number of problem agencies cited in various studies in recent years. If owners of home health agencies have not been previously barred from Medicare, they can obtain certification without having any health care experience. Although certified home health agencies must be periodically recertified, serious deficiencies in the process allow problems to go undetected. Once certified, home health agencies have little reason to fear that they will suffer serious consequences from failing to comply with Medicare's conditions of participation and associated standards. Few problem home health agencies are terminated from the program; instead, they are given repeated opportunities to correct their shortcomings, even if the same deficiencies occur from one survey to the next. Moreover, the Health Care Financing Administration has not implemented a range of penalties to sanction problem home health agencies, even though Congress gave it the authority to do so more than 10 years ago.

GAO noted that: (1) becoming a Medicare-certified HHA is relatively easy-- probably too easy, given the large number of problem agencies identified in various studies over the past few years; (2) if HHA owners have not been previously barred from Medicare, they can obtain certification without having any health care experience; (3) although such entrepreneurs can hire qualified health care professionals, Medicare's initial certification survey is so limited that it does not provide a sound basis for judging an HHA's ability to provide quality care; (4) although certified HHAs must be periodically recertified, serious deficiencies in the process allow problems to go undetected; (5) HCFA recertifies HHAs by screening them against a subset of the conditions of participation, but when surveyors assessed 44 targeted HHAs against all applicable conditions of participation, almost half had problems serious enough to warrant decertification; (6) many HHAs operate branch offices, but these offices are not subject to the same oversight afforded the parent offices; (7) HHAs are resurveyed every 12 to 36 months, depending on a variety of factors, but rapid growth and high utilization rates, which may indicate potential problem HHAs, are not included among those factors; (8) once certified, HHAs have little reason to fear that they will suffer serious consequences from failing to comply with Medicare's conditions of participation and associated standards; (9) few problem HHAs are terminated from the program; instead they are provided repeated opportunities to correct their deficiencies, even if the same deficiencies recur from one survey to the next; and (10) moreover, HCFA has not implemented a range of penalties to sanction problem HHAs, even though the Congress provided it the authority to do so over 10 years ago.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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