title: Fraud. What is the evidence?
abstract: The home health industry complains that Medicare fraud and abuse initiatives and legislation, namely, Operation Restore Trust (ORT), the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and the Balanced Budget Act (BBA) of 1997 developed when home health care was vulnerable to reimbursement reductions from Medicaid and commercial insurers, particularly Health Maintenance Organizations. Additionally, it contends that the Health Care Financing Administration (HCFA) founded these initiatives on controversial government studies showing high rates of home health fraud and abuse and inappropriate assumptions that rising costs were indicative of fraudulent activities (Sarraille & William, 1998). We summarize reasons why the home health industry became a focus for enhanced Medicare fraud and abuse reduction efforts by HCFA and provide evidence supporting enforcement actions by HCFA's partners.
authors.affiliation: Health Care Financing Administration (HCFA), New York, NY 10278, USA.
authors.forename: J
authors.initials: J
authors.lastname: Berek
authors.forename: N
authors.initials: N
authors.lastname: Gutierrez
authors.forename: J
authors.initials: J
authors.lastname: Stone
authors.forename: L
authors.initials: L
authors.lastname: Testa
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D005607:Fraud; D020408:Health Insurance Portability and Accountability Act; D006699:Home Care Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States