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NCJRS Abstract

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NCJ Number: 73651 Add to Shopping cart Find in a Library
Title: Problems Associated With Home Health Care Agencies and Medicare Program in the State of Florida - Report
Corporate Author: US Congress
Senate Cmtte on Government Operations
United States of America
Date Published: 1976
Page Count: 121
Sponsoring Agency: National Institute of Justice/
Rockville, MD 20849
US Congress
Washington, DC 20510
Sale Source: National Institute of Justice/
NCJRS paper reproduction
Box 6000, Dept F
Rockville, MD 20849
United States of America
Document: PDF
Type: Legislative/Regulatory Material
Language: English
Country: United States of America
Annotation: A 1976 congressional investigation of Medicare payments to private agencies providing home health care services discovered numerous abuses and irregularities and recommended guidelines to regulate their operations.
Abstract: Based on testimony given by 28 witnesses in Tampa and Miami, Florida, the report begins with a historical review of the proliferation of home health care agencies in Florida since 1972. These facilities, while technically categorized as private, nonprofit agencies, are not subject to Government regulation and are generally controlled by a small group of persons who are not responsible to any larger organizations. Their nonprofit status is dubious because of the high salaries paid to administrators and the accumulation of capital funds. Testimony from newspaper reporters in Tampa documented kickbacks and referral fees paid by three home health care providers. Overutilization, when clients and Medicare are charged for unnecessary services, was the most common abuse cited by witnesses but the most difficult to substantiate. Other administrative abuses such as improper auditing procedures, unreasonable charges, and dishonest billing for medical equipment were also described. The committee examined conflict of interest issues which arose because of a doctor's ownership and professional involvement in a private nonprofit agency. Testimony given by proprietary home health care agencies, which will soon be eligible for Medicare reimbursements because of a new Florida law, suggested that they operated on a far less expensive basis than the so-called nonprofit agencies. The committee recommended that the Bureau of Health Insurance (BHI) of the Social Security Administration develop guidelines for private nonprofit agencies which would limit their charges and administrative salaries. The BHI should also aggressively monitor all claims submitted by these providers, although it presently does not have the manpower to initiate investigations. Other recommendations concerned legislatve or administrative changes to reduce expenses billed to Medicare and halt the rapid growth of private home health care agencies through national certification procedures. The committee suggested that these agencies undergo periodic review by a State council and reorganize their boards of directors to be more accountable to public interests. Correspondence among the committee and the agencies under investigation, State agencies, and national associations of home health care services is appended, along with newspaper articles on Medicare frauds.
Index Term(s): Conflict of interest; Florida; Medicaid/Medicare fraud; Medical fraud
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