Seniors may have to pay for Medicare home health

[Zoom-boing]

"At the extreme, this benefit can turn into a long-term care social support system," said commission chairman Glenn Hackbarth. "A modest copayment is one tool to help deal with that problem."

The advice comes as lawmakers face a tough budget year. A sluggish economy and tax cuts are draining revenue while deficits soar to ranges widely seen as unsustainable. Republicans won control of the House on a promise to curb spending, yet there's little hope of that unless Congress and the president can agree on ways to restrain health care costs.

More than 3 million seniors and disabled people on Medicare use home health services — visits from nurses, personal care attendants and therapists, available to those who can't easily get out of the house.

Home health was once seen as a cost saver, since it's clearly cheaper than admitting patients to the hospital. But it's been flagged as a budget problem because of rapidly increasing costs and big differences in how communities around the country use the benefit.

Part of the problem appears to be rampant fraud. In some counties home health admissions exceed the number of residents on Medicare.
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The charge would be collected for each home health agency admission, not for every visit by a nurse or provider. Patients can be under home health care for weeks at a time.

Seniors may have to pay for Medicare home health - Yahoo! News

First bolded: wouldn't coordinating the system across counties be another way to solve the problem?

Second bolded: "In some counties home health admissions exceed the number of residents on Medicare". Who is perpetrating the fraud? It doesn't sound like Medicare patients are, if the admissions exceed the number of residents on Medicare. So the conclusion would be that it is those who are either doing the admissions or someone(s) else within the system? Which brings me to this

Third bolded: "The charge would be collected for each home health agency admission". It would appear that fraud is coming from within the system and it is known that there are home health admissions exceeding the number of residents on Medicare, so to solve the problem they want to charge those who are not causing the fraud . . . those on Medicare?

Am I reading this wrong?

 

[Madeline]

It doesn't seem that way to me, Zoom-boing.

This is such an essential service to a person who needs it. I think they should attack the fraud, not the patients.

 

[Revere]

I worked in Medicare Home Health a while ago. The fraud mentioned in that story squares with my anecdotal recollections.

 

[Madeline]

One of my neighbors has cancer, and is slowly dying. Without home health care, she'd be in a nursing home. I just can't imagine adding to this lady's distress.

There has to be a better way.

 

[Revere]

Well, the country is $14T in debt. Lots of people will want something that won't be there.

 

[Madeline]

Well, the country is $14T in debt. Lots of people will want something that won't be there.

Ya, I know. But the concern here seems to be the level of fraud, Revere. Based on your experience, can't it be addressed?

 

[Revere]

In my opinion, no. The fraud becomes an incentive to stay in business. In Medicare Home Health, anyway.

Same thing happens in state subsidized day care.

 

[Zoom-boing]

It doesn't seem that way to me, Zoom-boing.

This is such an essential service to a person who needs it. I think they should attack the fraud, not the patients.

What doesn't seem that way?

I agree I think they should attack the fraud. My question is . . . where is the fraud coming from? Bogus people claiming to be on Medicare or via admissions or somewhere within the system or ? ? ?

 

[Zoom-boing]

I worked in Medicare Home Health a while ago. The fraud mentioned in that story squares with my anecdotal recollections.

Can you elaborate?

 

[Madeline]

It doesn't seem that way to me, Zoom-boing.

This is such an essential service to a person who needs it. I think they should attack the fraud, not the patients.

What doesn't seem that way?

I agree I think they should attack the fraud. My question is . . . where is the fraud coming from? Bogus people claiming to be on Medicare or via admissions or somewhere within the system or ? ? ?

I'd imagine part of the problem is anyone can form a Home Health Agency. You, the owner, need have no medical degree. That leaves the field wide open -- this is a problem with Durable Medical Equipment as well.