Home health care business and Medicare fraud is real.and you can help fight it.Home health care business and Medicare Fraud is something that you, the caregiver, or patient can fight and report. You might think that since your home health care physical therapist is so sweet and polite that passion is really at the top of the company they work for. It may be. It may not. Quality character does not necessarily reflect corporate America's worth ethic. Our government does what they can to fight fraud but there are always loopholes and gray areas that a home health care business will find and take advantage of. Let's look at how a home health care business is paid by Medicare to see a patient. Medicare is set up to pay a home health care business a lump sum of money to manage your care for every 60 days. It's called P4P - Pay For Performance. And how much money do they get to take care of you? That depends on how sick you are. And on the discharge end, it depends on how much better we can get you. But, as you've already guessed, even if you aren't much better or better at all, clinicians can still write down what they want... this means that you may be far better on paper than you are in real life. We're talkin' home health care business and Medicare Fraud here. So, if I can tell the payer source that you are sicker than you are and then better than you are at discharge, the home health company gets paid more. No is around to make sure that the evaluation documentation reflects your true condition. Just a few short years ago, most hospitals had their own home health care unit. They generally saw their own patients as they came out of the hospital. The point? Most people coming right out of the hospital are likely sick and weak. As the years progressed and Medicare changed their reimbursement system, private agency's popped up all over the place. Since they are not hospital based, they take anyone and everyone they can find. The point? Many are not sick, not homebound , not in need of home care, yet private agency's will sweep them up. Why? Of course - $$$$$ You may have tripped over your dog but that does not mean that you need home care with a ticket price of $2000-$4000 (more or less depending on how sick you are or aren't - or how sick we make you on paper) per 60 day episode. Just be careful around your dog next time. OK, quite another story if you tripped over your dog and broke you hip! You get my point. Many private agency's will take whomever, where ever for whatever reason. The really BIG DEAL here is that they will get paid even more if they can send physical therapy (PT) in! Sometimes physical therapy is not needed. Sometimes it is for a short time. But, PT can tend to somehow drag on and on from one 60 day episode to the next... make sure it is necessary. And remember, it is your patient right to refuse care. Remember the home health care business - it's not a profession anymore, it's a business. If you don't want care, you can refuse that care. I've seen more company's talk a patient into getting services they did not want or did not need. Stand up for your rights! Protect your kids and grandkids! Make sure we have health care when we need it by NOT accepting a service that you don't want or feel you don't need. Interested in doing your part for the economy, for the green movement, for future generations? Talk to your doctor first about home health care and your needs instead of calling up an agency. You can also ask me! With 16 years of Home Health Care Experience, I may be able to save everyone money. But if I think you really should get some help, I'll tell you! Remember I said every 60 day episode? That's right, big bucks to the home health care business if they think you need more physical therapy. You may have reached your goals. If you have, tell them you are good to go and ready for discharge. If you haven't met your goals, and don't feel like physical therapy is helping, cancel it all together. Frustration can mount when goals aren't becoming reality but remember that home health care is very unsupervised, is good and sometimes (unfortunately) easy money and not all physical therapists are doing their job. (See What to Expect ) to understand more about what to expect from home care physical therapy. Also keep in mind that most home health care agencies are not hospital based anymore - largely due to the Medicare reimbursement structure in hospitals. So, agencies have become privately owned and stand alone. Thus, they must go out and seek/advertise for their clientele. In the good old days, the hospital based agency had their own steady stream referral source of patients... as patients were discharged from the hospital and in need of home health care, they were simply referred for these services. Now, marketers must go out and plead for business. Every agency flaunts their own trademark - why you should choose them. Whether a special balance, diabetes or cardiac program, high tech gadgets, or extra services, your ultimate rehab success comes down to YOU. You are the only one who can do what your physical therapist tells you to. I call it homework and greater than half of my patients don't do it (their home exercise program) and tell me they do. We'll talk about why this is later on but suffice it to say that feeling a sense of accomplishment in home health care physical therapy can be illusive on more than one occasion. As a patient, you have rights. If you don't want physical therapy you have the right to refuse it, period. We are required to explain the potential consequences of this decision to you, so be ready for a gentle 'lecture.' But, stand up for your rights. Do you part in protecting our future generations. If Medicare fraud continues in home health care businesses like it is now (and in most other health care entity's) our kids and grandkids will be on their own for health care. Help to take the Business out of Home Health Care Business. Keep our founding forefathers business ethic the standard it should be.
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