Sunday, December 28, 1997

Home Health Care: Industry's structure invites abuse

By Jane Hays

Anita Bradberry, a Dec. 21 Readers' Forum guest columnist, addressed the federal cutbacks in Medicare spending and benefits for home health care. Her comments painted a black picture for home health care for the elderly. She failed to mention why the cutbacks are occurring.

Medicare, as we all have heard, is in financial trouble, and if something is not done, it very well may not be around in the future.

Based on my experience and observation, the major reason for this financial crisis is massive abuse and even fraud. Contributing to that is a lack of understanding of the abuse and fraud and even apathy, when we do understand it, on the part of the recipients and their family members. Aggressively addressing these problems now will go a long way in saving Medicare as we know it today.

Unfortunately, greedy health care providers -- and they exist in all segments of health care -- are not only overcharging for services provided but are charging for services not needed and sometimes never delivered.

When my mother became ill three years ago, I was amazed that some doctors ordered tests that were not indicated. When I questioned them, the response was, "Why do you care? Medicare will pay for it."

One hospital charged for care not received. When I asked for an itemized statement to compare it to what Medicare and her supplement were charged, I was told I did not need a statement and to this day have never received one despite the fact that Texas law says hospitals have to provide one upon request.

Home health care was wonderful and allowed me to keep my mother at home for a longer period of time before her death. However, when word somehow got out that she needed it, I was besieged with competing home health care agencies wanting to be the provider.

One came to see me from 150 miles away in spite of the fact that there were many in my area, and some pushed to provide more services than she really needed. Why? Medicare, Medicare supplements and Medicaid had almost written a big blank check for home health care.

As I understand it, not only could providers charge for the actual cost of care, but they could also add mileage and extra administrative costs -- an invitation to abuse and fraud.

Many home health care providers did not "milk" the system, and they should be commended. Those who did deserve this cutback and more.

It should be made clear it is a cutback. Bradberry's column left the impression that there would be no home health care service under Medicare after Jan. 1, 1998. Services will be paid for but limited, and it is possible that Medicare may not pay for some of the services that some elderly people will need.

If the recipients of Medicare and their families would be more mindful of abuse and fraud and demand that it stop, we might not have as many cutbacks in the future, and we might even save Medicare. Question providers, demand itemized statements and report abuse and fraud.

Jane Hays is a resident of Ballinger.