Rampant home health fraud in Ohio prompts action from legislators

February 3, 2015 | By Evan Sweeney

An in-depth investigation published in December by the Columbus Dispatch exposed a home health industry in Ohio that is rapidly expanding, often at the expense of taxpayer dollars. But now lawmakers are taking a hardened look at how to better regulate the industry and root out instances of fraud and abuse.

The newspaper's special report found that Columbus has the most Medicare-certified home health agencies per person among the 50 largest metro areas in the country. However, the Department of Health and Human Services' Office of Inspector General found that 18 percent of agencies across the state had questionable billing, twice the national average. Furthermore, just five percent of Medicaid spending is devoted to home health agencies, but the industry has accounted for more than half of improper Medicaid payments over the last three years.

According to an update from the Dispatch, the investigation has prompted lawmakers to take a closer look at fraud and abuse within this sector of healthcare. Although the home health industry argues that providers must be certified by Medicare, the Dispatch notes that even Medicare-certified home health agencies have been exposed to fraud and abuse. At least 19 active or closed Medicare-certified agencies have been excluded from billing Ohio Medicaid, and 62 percent of Medicare-certified agencies were subject to at least one complaint investigation between 2009 and 2014, according to the newspaper. In one particularly egregious case, a home health aide at Atlas Home Health Care was charged with raping his client's 17-year-old sister. A subsequent review found the wrong person listed as the CEO and a lack of proper background checks for employees.

On Monday, Gov. John Kasich (R) released a state budget that featured a four-year phase-out of independent providers that bill Medicaid for home health. Beginning July 2016, no new providers will be able to bill Medicaid for home health services, and by July 2019, only 800 Medicare-certified agencies would be permitted to submit claims. The proposed budget also authorizes an "electronic visit verification system" in order to ensure home care visits are actually occurring.

State programs around the country that provide better access to home healthcare are often vulnerable to fraud and abuse and fraud convictions, indictments and investigations continued to pour in throughout 2014. Ohio is not alone in its inefficient oversight of home health. As FierceHealthPayer: Antifraud previously reported, states like Minnesota fail to recoup millions in fraudulent home health payments.

For more:
- read The Columbus Dispatch's special investigation
- here's the newspaper's updated article
- see the state's budget proposal