Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes
HEHS-95-23
Published: Mar 30, 1995. Publicly Released: Apr 19, 1995.
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Highlights
Pursuant to a congressional request, GAO reviewed billings for inappropriate or undelivered therapy services, focusing on overcharges to Medicare nursing home patients.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to set explicit limits to ensure that Medicare pays no more for therapy services than would any prudent purchaser. |
Closed – Implemented
HCFA's proposed salary equivalency guidelines for contracted physical therapy and respiratory services, speech language pathology, and occupational therapy services were released as final rules earlier this year (April 1, 1998). This is expected to save $240 million in FY 1998 and 1999.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to strengthen certification requirements to better ensure that those entities billing Medicare are accountable for the services provided to the beneficiaries. |
Closed – Not Implemented
With the implementation of PPS, services are no longer billed to Part A.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to define billable therapy service units so they relate to the time spent with the patient. |
Closed – Not Implemented
HCFA officials do not agree that establishing a uniform definition of time units is necessary. They believe that it is more useful to precisely identify what was done rather than how much time was spent doing it. The Administration's Medicare legislative proposals include provisions requiring use of HCFA Common Procedures Coding System codes for this process.
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CompensationFederal regulationsFraudHealth care personnelHealth insurance cost controlInvoicesMedicaidMedical expense claimsMedical services ratesMedicareNursing homesOverpayments