Monday, June 17, 2013

Home health care helps make Dallas' Medicare spending among highest in nation

By JIM LANDERS, Washington Bureau
Published: 16 June 2013 10:03 PM
Updated: 17 June 2013 12:14 AM


Home health care, an industry plagued by allegations of fraud and abuse, is the biggest reason why Medicare spending in Dallas County is among the highest in the nation.
A recent report by the U.S. Health and Human Services Department’s inspector general found suspicious billing activities at 1,000 of the 2,212 home health agencies in Texas in 2010. The report recommended a moratorium on accepting claims from new home health care agencies in Texas until the billing practices were sorted out.
A separate report in March by the Medicare Payments Advisory Commission found Texas accounted for 13 of the 25 U.S. counties with the highest spending on home health care. (Dallas County was not on the list.) For every 100 Medicare beneficiaries in Duval County, Medicare was billed for 152 visits by home health care nurses, therapists and health aides.
(In Dallas, Medicare was billed in 2011 for 62.5 visits per 100 beneficiaries. The national average that year was 19.6 visits.)
“Our work with law enforcement has shown us that there is tremendous fraud going on, particularly with home health,” said Jon Blum, director of Medicare Services, during a congressional hearing Friday.
Federal prosecutors last year charged two Dallas physicians and several home health care agencies with fraudulent Medicare billings worth more than $450 million.
Dallas County Medicare spending per beneficiary fell in 2011, the most recent year available for spending data. But spending under the federal insurance program for the elderly and disabled was still 25 percent higher in Dallas than the national average. Among the nation’s most populous metropolitan counties, only Miami-Dade County in Florida and Harris County, Texas, spent more.
Fraud concerns
Most of the difference between the Dallas County and national spending averages was because of the higher use of home health care.
Medicare spends an average of $1,624 for home health care for each Medicare beneficiary in Dallas County, while the national average is $546.
Rachel Hammon, executive director of the Texas Association for Home Care & Hospice, said seniors get treatments and rehabilitation for serious medical conditions by skilled health workers at home that would cost far more in institutions such as inpatient nursing facilities.
But she said the association shares the concern about fraud and has endorsed the moratorium recommended by the federal inspector general’s August report. There are now 2,949 home health care agencies in Texas eligible for Medicare payments.
“Certainly nobody, none of our providers appreciates fraudulent agencies,” she said. “We have fraud and abuse education at every meeting.”
The association is hosting a meeting next week with federal officials for home health care agencies along the Rio Grande Valley, where several of the highest-use counties are located.
Post-acute care costs
Recent Medicare data shows spending in Texas, Louisiana and Florida exceeded the national average by 10 percent or more between 2007 and 2011.
The biggest factor in high Texas spending was costs for post-acute care — charges incurred after patients are released from hospitals and enter treatment at home or at inpatient residential facilities, skilled nursing facilities or long-term acute care hospitals. Spending in Dallas County on post-acute care was $1,608 per beneficiary higher than the national average in 2011. Hospital charges, meanwhile, were just $81 above the national average.
The high Medicare spending in Dallas County held true for Tarrant and other North Texas counties as well, according to the recent data. Medicare spending in Collin, Denton and Tarrant counties was 12 percent to 24 percent above the national average in 2011. In each county, spending on home health care was at least double the national average.
Follow Jim Landers on Twitter at @landersjim

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