Doctor House Calls Proposed in Congress Despite Rampant Home Healthcare Agency Fraud

Doctor house calls may be returning as a bipartisan bill, the Independence at Home Act of 2016, is introduced today into Congress to extend Medicare’s current demonstration project to a nationwide program.

We’ve yet to see any major media coverage of the bill or its text but several organizations have now released press releases supporting it so it should be imminent.

The pilot program chose 17 practices to participate and treat high-need Medicare beneficiaries through in-home primary care visits available 24 hours a day. In order to participate, patients had to meet five requirements, including the presence of two or more chronic conditions, a non-elective hospital admission as well as rehabilitation services in the last year, and needing assistance with two or more functional dependencies (for example, feeding and walking). The goal was to improve treatment of the costliest patients: disabled and chronically ill Medicare beneficiaries.

Section 3024 of the Affordable Care Act mandated Medicare test home-based primary care to determine whether it could reduce health care costs and improve outcomes. The first phase of the program ran from 2012 to 2015. The data released concerning the first year of the pilot program, where over 8,400 Medicare beneficiaries were treated, indicated it saved the U.S. Government more than $25 million. The Centers for Medicare and Medicaid Services also found that patients in the program had fewer hospital readmissions within 30 days and used inpatient and emergency department services less.

The timing of the bill’s introduction into Congress is interesting in that it follows shortly after an OIG report on the extensive fraud among Medicare’s home health care providers. The OIG announced the Government’s increased enforcement efforts in this area and commented on a study that found more than $10 billion in improper payments in fiscal year 2015.

Home health care fraud among providers of nursing and therapy services has been a major problem area recently. In order for home care by doctors to be successful, there need to be safeguards put in place to ensure that the problems seen in HHA billing does not also encompass the new program for physician in-home treatment.

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