Government paid out billions in suspect Medicare claims — report

Medicare paid out $2 billion in error because nearly a third of the claims it reviewed did not adequately document face-to-face encounters with beneficiaries who seek home health services such as nursing care or physical therapy, a federal inspector general has found.

The new health care law requires physicians or other practitioners who certify beneficiaries to document their in-person encounters, a measure designed to combat fraud.

The Health and Human Services Department’s inspector general reviewed 644 face-to-face encounter documents to see if they met the requirements, and found serious shortcomings.

“For 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made,” Inspector General Daniel R. Levinson wrote in his report. “Furthermore, physicians inconsistently completed the narrative portion of the face-to-face documentation.”

Prosecutors have pointed to home health care as a burgeoning front in Medicare and Medicaid fraud. Last month, federal authorities announced the “largest health care fraud takedown” in D.C. history, charging 25 people in and around the nation’s capital with bilking Medicaid for millions by falsifying credentials or coaching patients to report trumped-up symptoms.

The inspector general said the Centers for Medicare and Medicaid Services should consider a standardized form to make sure physicians comply with in-person documents rules, find ways to better relate the requirements to doctors and develop better oversight of the requirement.

In a response included with the report, CMS officials said they concurred with each of the recommendations.