Medicare: Allegations Against ABC Home Health Care (Testimony, 07/19/95,
GAO/T-OSI-95-18).

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.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-OSI-95-18
     TITLE:  Medicare: Allegations Against ABC Home Health Care
      DATE:  07/19/95
   SUBJECT:  Home health care services
             Medical records
             Patient care services
             Health care personnel
             Fraud
             Questionable payments
             Program abuses
             Medical expense claims
             Forgery
             Gifts or gratuities
IDENTIFIER:  Medicare Home Health Care Program
             
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