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Medicare Overpaid Doctors up to $2 billion for Unsubstantiated Home Visit Claims

According to an April 2014 report issued by the Department of Health and Human Services (HHS), the Office of the Inspector General (OIG) found that 32 percent of a population of home health claims submitted for Medicare reimbursement failed to meet documentation requirement, possibly costing Medicare up to $2 billion.

Pursuant to President Obama’s Patient Protection and Affordable Care Act (ACA), physicians are required to conduct a face-to-face visit first to confirm that patients who request home care are too ill to travel to a hospital or doctor’s office.  In addition, doctors are required to provide specific evidence that they are in fact making the house call.

“The Medicare program doesn’t really have a system in place to ensure the providers are meeting the face-to-face requirement,” said Danielle Fletcher, a program analyst in the IG’s Office of Evaluation and Inspections.  “Medicare has found a lot of fraud in home health.  The expectation is that the face-to-face visit helps prevent that fraud by ensuring the physicians see and assess the patient, and document that visit and assessment.”


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