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HEHS-95-260R 1 (1995-09-05)

handle is hein.gao/gaobackxr0001 and id is 1 raw text is: 3AO United States 3A 0 General Accounting Office Washington, D.C. 20548 Health, Education and Human Services Division B-265949 September 5, 1995 The Honorable William M. Thomas Chairman, Subcommittee on Health Committee on Ways and Means House of Representatives Dear Mr. Chairman: We recently issued a report about abusive billing practices for therapy services furnished to nursing home residents who are covered by Medicare.' In that report, we identified a number of methods that therapy providers used to maximize Medicare payments and made recommendations to the Secretary of Health and Human Services designed to remedy the problems through better controls. Subsequently, your office asked us to suggest how our recommendations could be implemented legislatively if the Subcommittee decided to do so. Noting that proposals have been made to require nursing homes to bill for all services furnished to residents rather than allowing outside suppliers to bill Medicare directly, your office also asked that we address how such a requirement could be accomplished legislatively. Therapy services--physical, occupational, and speech--are covered under both part A and part B of Medicare, and nursing home residents can have their therapy paid under either part depending on the circumstances. If the resident qualifies for Medicare skilled nursing facility services, part A pays for necessary therapy. However, most nursing home residents do not qualify for skilled nursing facility care, and those that qualify usually only do so for relatively brief periods--the average covered stay was about 38 days in 1994, with an absolute limit of 100 days. Most other nursing home residents, including those dually eligible for Medicaid, have Medicare-covered therapy services paid by part B. 'Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes (GAO/HEHS-95-23, Mar. 30, 1995). GAO/HEHS-95-260R Preventing Abusive Medicare Billing

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