Home Health & Hospice Week

But home care audits are relatively few.

The Government Accountability Office continues to highlight home care fraud in front of Congress. In testimony before two congressional committees, the GAO pointed out home care fraud-related activities.

On June 8, the GAO's Kathleen King testified before the House Energy and Commerce Subcommittee on Oversight and Investigations. King made note of the 78 HHAs whose payments were suspended in conjunction with the fraud case against Dr. Jacques Roy in Dallas, according to her testimony, "MEDICARE: Progress Made to Deter Fraud, but More Could Be Done."

"Suspending payments to providers suspected of fraudulent billing can be an effective tool to prevent excess loss to the Medicare program while suspected fraud is being investigated," King told the committee. "While [the Centers for Medi-care & Medicaid Services] had the authority to impose payment suspensions prior to PPACA, the law specifically authorized CMS to suspend payments to providers pending the investigation of credible allegations of fraud."

CMS has suspended payments for 212 providers since the ACA provision took effect, with half of the suspensions occurring this year, King reported. The suspensions prevented about $6 million in Medicare claims from being paid out.

But while home health agencies may feel overly targeted by fraud-fighting efforts, they aren't getting hit with audits like other provider types, King and the GAO's Carolyn Yocom said in a June 7 hearing before the House Oversight and Government Reform Subcommittee on Government Organization, Efficiency, and Financial Management. From 2008 through 2012, only nine federal audits have focused on home health agencies -- 1 percent of total federal audits, according to their testimony, "PROGRAM INTEGRITY: Further Action Needed to Address Vulnerabilities in Medicaid and Medicare Programs." That compares to 45 federal audits (3 percent) for durable medical equipment suppliers and 584 audits (38 percent) for hospitals, for example.

State audits were more home care-heavy. Collaborative audits -- those which were conducted by state Medicaid integrity programs -- totaled six for home health, which was 5 percent of all collaborative audits conducted. That compares to 35 audits (31 percent) for pharmacies and 33 audits (29 percent) for long-term care facilities, according to the testimony. The testimony is online at www.gao.gov/assets/600/591452.pdf and www.gao.gov/assets/600/591425.pdf.