Medicare Fraud

REPRESENTING CLIENTS IN ATLANTA, AUGUSTA, COLUMBUS, MACON, SAVANNAH, GAINESVILLE, LAWRENCEVILLE, DECATUR, JONESBORO & THROUGHOUT GEORGIA

A recent Wall Street Journal analysis of Medicare payments to home health care companies raises concerns that some are gaming the Medicare reimbursement system. The investigation shows that some home health care providers, including the nation’s largest, Amedisys, Inc., raise revenues by taking advantage of Medicare incentives for in-home therapy visits.

The federal government’s Medicare program determines reimbursements partly by the number of in-home therapy sessions a patient receives. When a patient gets 10 visits, reimbursement doubles.

Medicare pays a flat fee of $2,200 for up to nine initial visits. When a patient gets that 10th session, the company gets another check of approximately $2,200.

Many Amedisys patients require just enough therapy to qualify the company for the additional $2,200, according to the Journal. From 2005 to 2007, few patients received only nine visits. In 2007, less than 3 percent received nine in-home therapy sessions, while nearly 10 percent had 10 visits.

That 10th visit is extremely profitable: An individual session costs the company less than $80.

Amedisys says between 55 percent and 60 percent of its patients receive at-home therapy. According to the Journal, more than a quarter of those patients received 10 to 12 therapy sessions, netting the company that extra $2,200 payment.

Those golden numbers have caught the eye of some members of Congress. The Senate Finance Committee is investigating Amedisys and three other home health care providers that receive Medicare reimbursements.

The senators are examining allegations that the companies are boosting home therapy sessions in order to trigger the second Medicare reimbursements.

The other companies under investigation are Gentiva Health Services, Inc., LHC Group, Inc. and Almost Family, Inc.

If you have knowledge of Medicare fraud by home health care companies, contact a Georgia attorney who can assess your situation and explain your legal options.