Home care benefits drive losses and gains


Medicare and Medicaid in-home care made news last week in stories showing that the same service setting can drive program dollar losses or savings depending on providers and patients involved.

"Recent prosecutions have highlighted serious program integrity weaknesses in both consumer-directed and agency model of home care," the National Association for Home Care & Hospice (NAHC) reported. Cases in three states prove this point, according to the article:

  • Alice Santiago, a caregiver in New York, billed Medicaid for 186 hours of nightly home services to a family member though Santiago allegedly worked elsewhere during these hours.
  • Owners and staff of Majestic Home Care Services, LLC in Louisiana are accused of enlisting Medicaid patients to sign caregiver timesheets for services not rendered. In return, patients received a cut of the proceeds.   
  • And St. Jude Home Care in Rhode Island is accused of fraudulently billing $250,000 in combined Medicare and Medicaid claims. Federal authorities revoked the provider's billing privileges for both programs.

Agencies should beef up their service documentation systems and audit patients to ensure they received claimed home care, NAHC recommended.   

Against the backdrop of these fraud risks comes news on how house calls to the elderly may save Medicare money by keeping them out of hospitals and specialists' offices. House call utilization is quietly rising, with Medicare paying $2.8 million for house calls in 2012 as opposed to $1.5 million about 10 years ago, according to the San Francisco Chronicle.

Washington geriatrician Eric De Jonge, M.D. and his colleagues compared costs and survival rates of 722 patients in their house call practice with claims histories of 2,161 medically-equivalent beneficiaries who didn't get primary care at home, the Chronicle reported. Death rates were similar; but in two years, total Medicare costs were 17 percent lower for house call patients, with average annual savings approaching $4,200 per beneficiary.

A Medicare demonstration project is now underway to test the savings potential of house calls, the Chronicle added.

For more:
- read the NAHC article
- here's the San Francisco Chronicle article

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