Grassley organized the round table with Sen. John Breaux of Louisiana following a congressional hearing in July that focused on waste, fraud and abuse within the home health care industry. The hearing of the Senate Special Committee on Aging -- where Grassley is the Chairman and Breaux is the Ranking Member -- revealed systemic abuse of the Medicare home health benefit by a small number of problem providers. Grassley and Breaux said they will use the information gathered at the round table, along with the ideas brought forward at the committee hearing this summer and careful study, to develop a legislative initiative to attack all aspects of fraud, waste, and abuse.
"Senator Breaux and I are working on this issue because we are both very strong supporters of home health. Home health care can help people live fulfilling lives at home, not in an institution. Further, it can be cost-effective for the Medicare program," Grassley said. "The problem is that bad providers in the system are causing skyrocketing costs that threaten the entire benefit. Sen. Breaux and I want to protect and preserve the valuable home care benefit. Our ultimate goal is producing legislation designed to protect and encourage the quality provider while eliminating the problem provider."
According to the General Accounting Office (GAO), the number of home health agencies grew from 5,692 in 1989 to 10,133 in 1997. The number of home health beneficiaries grew from 1.7 million in 1989 to 3.9 million in 1996. Spending on Medicare home health grew from $2.6 billion in 1989 to $17.7 billion in 1996.
Following the Grassley-sponsored hearing in July, President Bill Clinton announced a plan designed to curb fraud and abuse in the Medicare home health care program. Grassley said the President's action is a step in the right direction but the problem warrants a more comprehensive solution. In fact, Grassley said a convicted home health felon who testified at his hearing would have easily passed all of the new requirements proposed by the President.
"This important program and complex problem deserve much more than just a quick fix. They need a comprehensive solution that will preserve the home health benefit for the millions who depend on the program. The insight of the home health care experts gathered today should help us develop a good bill," Grassley said. The officials participating in the day long discussion to review various proposals for cleaning up home health care were: George Grob, Office of the Inspector General (OIG) for the Department of Health and Human Services; Leslie Aronovitz and William Scanlon, GAO; John Molesworth, Federal Bureau of Investigation; Linda Ruiz, Health Care Financing Administration Program Integrity Group; Roslyn Mazer, Department of Justice; Mary Ellis, Wellmark, Inc. in Des Moines; Bobby Jindal, Louisiana Department of Health and Hospitals; Michael Costello, Veterans Affairs Office of Inspector General; George Fields, Internal Revenue Service; William Dombi, National Association for Home Care.
During the July hearing of the Committee on Aging, the OIG released two reports detailing the extent of fraud within the home health system. The reports also revealed that a small number of problem providers control an extraordinary amount of total Medicare expenditures on home health care. The first OIG report focusing on five target states found that 25 percent of the home health providers were considered "problem providers," or one who routinely submits claims to Medicare that contain significant, inappropriate and unallowable costs. Even more shocking, the problem providers -- that 25 percent -- receive 18 percent of all nationwide Medicare spending on home health care.
The second OIG report focused on four target states. The OIG found that 40 percent of home health care claims in these states were "improper" and should not have been paid. While not all of these claims were related to fraud, the report revealed major shortcomings in Medicare's payment system for home health care.