This is a significant vulnerability that could be exploited by unscrupulous agencies, the OIG says. Home health has long been recognized as susceptible to waste, fraud and abuse.
Back in 1995, one notable fraud case involved a Georgia-based home health agency investigated at the request of a congressman, resulting in a seven-year prison sentence for the CEO after he was convicted on dozens of counts of fraud.
The problem hasn’t ceased. From 2011 to 2015, OIG investigations involving home health resulted in more than 350 criminal and civil actions.
In a related issue, the OIG says, one agency may have discharged patients to avoid surveyor scrutiny.
Medicare only pays for home-based care if it is requested by a physician as medically necessary for home-bound patients. The care can include nursing services, physical therapy, and a home health aide.