or those who are ailing but hope to stay out of nursing homes or hospitals — and who wouldn’t? — there’s an increasingly popular alternative: home health care providers. These are doctors, nurses and other medical staffers who visit patients at home, with the goal of treating chronic conditions and keeping people healthy enough to avoid costly long-term stays in more intensive facilities. That saves patients, and the health care system, money.
But, as with all things in the health field, there are plenty of caveats for potential customers.
Illinois is a field of dreams for home health care fraud, the Tribune’s Michael J. Berens reports. Why? Because state public health regulators doled out too many home health licenses too fast in the past decade. The state allowed almost anyone with a $25 licensing fee to open a home health care business but fails to provide meaningful oversight on hundreds of operators. You can find Berens’ full report atchicagotribune.com/homehealth.
The upshot of lax oversight: In the last five years, area home health agencies have improperly collected at least $104 million in Medicare dollars, Berens reports. (Most patients in home health care are covered by Medicare.) Often the home health businesses did that by falsely certifying that Medicare patients were homebound and in need of nursing care.
But the problem here isn’t measured only in Medicare dollars wasted. It’s measured in patients at risk or harmed. Thousands of patients have been subjected to unwarranted procedures, therapies and tests; some were prescribed unneeded and powerful drugs, the Tribune analysis concludes.
So what can patients, and their families, do to protect themselves? How can someone in Illinois — or her family — shop smartly for a home health care provider? It’s not easy, but here are a few tips:
- First, you can check a federal website that offers star ratings for home health providers at medicare.gov/homehealthcompare.
- Then, be vigilant. Make sure a home health care agency coordinates care with your existing primary physician. If a home health care company makes lots of visits but does little more than check your blood pressure, be wary.
- Check your monthly Medicare statement to monitor services that a home health care company claims to have provided.
On average, some 10,000 Americans turn 65 every day. That means the market for home health will likely continue to surge, placing greater demands on regulators.
In 2013, the federal government banned Illinois from issuing new licenses. The feds said that fraud was rampant, driven by too many home health companies for too few patients. Still, Cook County has more home health companies than the entire state of New York.
Many companies provide excellent care for their customers. The industry’s trade association, the Illinois Homecare and Hospice Council, represents about 160 providers (among the 750 or so licensed in the state).
“We support the moratorium,” Executive Director Sara Ratcliffe told the Tribune. “We want more enforcement.”
So do we. This field of dreams needs to be weeded of fraudsters. At least 357 active home health companies in the Chicago area have been linked to potential financial fraud by federal investigators but never charged.
That’s a daunting fact for families and patients seeking home health care. The state could help prospective patients by posting disciplinary and enforcement actions on the web. More sunshine — readily available information on providers’ performance and disciplinary records — would help them make a wise choice.
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