Physician home visits are under scrutiny by CMS for any possible fraud. In 2012, Medicare paid home care service providers about $236 million. As the population of Medicare age recipients increases it seems likely that the need for home care services will also increase. There are many benefits to providing home care services such as treating the chronically ill without the added cost of transportation, preventing possible hospital admissions or re-admissions.
However, the major deterrent for providers to participate in home care services is their transportation costs. Medicare does not reimburse the provider’s travel expenses or time. If the provider can avoid more expensive treatments for the homebound patients, the home care service providers may be eligible for financial incentives as part of the ACA.
States with less regulated home care services have the highest billing rates. Michigan does not require home health care licensure and it is no surprise that this state’s provider payments alone account for almost $40 million of total Medicare billing in 2012. One Michigan physician billed Medicare for home visits while he was traveling out of the county. Another physician repeatedly billed for services that would have taken more than 24 hours to perform in one day and also billed for home care services on patients who were either hospitalized or were deceased at the time of service.
Florida is another state with an enormous crackdown on home health care fraud thanks to the Miami Medicare Fraud Strike Force. Since 2009, 191 of the 202 defendants charged have been convicted for falsely billing Medicare for over $570 million. In 2010 a precipitous drop in payments occurred and payments remain essentially unchanged.
Statistics indicate a need for home care visits even though it will become unaffordable for Medicare if the service continues to be plagued with fraud. According to the American Academy of Home Care Medicine about 4 million patients presented with medical necessity for a home visit in 2012. Unfortunately, less than 20% of these received a single visit by a physician.