In its role of overseeing the Medicare and Medicaid Programs, the Senate Finance Committee released a staff report alleging that the four largest publicly traded home health agencies were providing medically unnecessary care by encouraging therapists to meet the 10 visit threshold in order to receive a “bonus” payment under the PPS system. The report was based on an investigation initiated by Committee Chairman Max Baucus and Senior Member Chuck Grassley. The Senators instigated the investigation based upon a Wall Street Journal analysis.
Among other findings, the report alleges that an analysis of therapy billings from these home health agencies show a pattern of concentrated billings at or just above the 10 visit threshold. The report further alleges that the companies encouraged billing of medically unnecessary services to reach this threshold.
Home Health Agencies should be aware that Medicare contractors will likely be closely scrutinizing PT visit frequency and patterns. Also, providers are likely to see changes in the payment system as a result of this report.
If you have any questions regarding Medicare or Medicaid coverage policies, or need assistance with a Medicare audit or investigation, please contact a Wachler & Associates attorney at 248-544-0888.