Saturday, December 6, 2014

Medicare House Calls are on the Rise -- So is Fraud

Medicare spending on doctors who make house calls rose to $236 million in 2012 — a 40% increase since 2006. But the effort to help aging patients with limited mobility get medical care has been riddled with fraud due to lax regulations in some areas of the U.S.
Nowhere is this more pronounced than in Michigan, where nearly a fifth of all the spending on Medicare home visits nationwide takes place. In 2012, physicians in Michigan received Medicare funds for home visits equal to 42 other states combined, a USA TODAY data analysis reveals. The result: more than $60 million in fraudulent billing by Michigan doctors in the past few years.
Advocates say demand for home-visit services has skyrocketed nationally as a generation of seniors ages in place, and that Michigan's payments have boomed because it is home to several major visiting-physician businesses. Recent studies suggest that home visits, where doctors examine patients and perform tests, can reduce the likelihood of repeat hospital stays and drive down overall Medicare costs.
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But others say the state's lax regulations have led to a surge in providers, some of whom have exploited the system by submitting false bills or charging for more work than provided.
"It's bad," U.S. Assistant Attorney General Leslie Caldwell says of the prevalence of fraud around home care. "And it's just an easier thing to do in Michigan than in other states."
A string of high-profile indictments in Michigan have led some to question whether home visits are doing the intended good.
"These tend to be some of the most vulnerable people in our state," says state Sen. Mark Jansen, who has pushed for more regulation on behalf of Michigan's seniors. "We want them to stay in their homes, but we need to figure out how to protect them from bad people. We have an obligation to do something."
In recent years, 14 doctors in Michigan, most in the Detroit suburbs, have been indicted in fraud cases centered on home visits, Caldwell says.
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