Home Health Care Firms Slammed by Senate Report for Gaming Medicare

Some private home health care companies have “gamed” the system by targeting the most profitable number of therapy visits, regardless of patient need, a Senate Finance Committee report found in September.

Amedisys, LHC Group and Gentiva were found to be conducting the practice of pushing home visits on patients to reach the 10-visit threshold after which Medicare payments for the patient increase, generating extra revenue for the companies providing the care.

“Therapy visit records for each company showed concentrated numbers of therapy visits at or just above the point at which a ‘bonus’ payment was triggered in the prospective payment system,” the report states.

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The inquiry began following a Wall Street Journal analysis finding that four companies, including the three noted by the Senate Finance Committee, were taking advantage of the Medicare therapy payment system by providing care that was not necessary for patients.

The 10-visit threshold was implemented in the late 1990s and was later modified in 2008 in an attempt to deter companies from “gaming” the system. However, a tiered program remained and was still susceptible to abuse, the committee noted in background information in the report.

Analysis of the three companies showed that each conducted a slightly different practice of boosting therapy visits to gain additional Medicare reimbursements under the 10-visit threshold, the Committee reported. Findings on Amedisys show management developed therapy programs to target the most profitable Medicare therapy treatment patterns and pressured therapists toward maximizing Medicare reimbursements. LHC Group managers instructed employees to drive the number of therapy visits to increase case mix, and Gentiva developed a competitive ranking system for management aimed at therapy visit patterns toward more profitable thresholds.

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“The gaming of Medicare represents serious abuse of the home health program,” said Sen. Max Baucus, (D-Mont), the committee’s chairman, in a statement. “Elderly patients in the Medicare system should not be used as pawns to increase a company’s profits. Especially in these tough economic times, taxpayers simply cannot afford for their dollars to be wasted on unnecessary care.”

View the Senate Finance Committee report.

Written by Elizabeth Ecker

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