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Date: Thursday, June 29, 1995
For Release: Immediately
Contact:  HHS Press Office (202) 690-6343
          OIG Press Office (202) 619-1142

"Today's alert is the first in a series of new fraud alerts that the inspector general will issue over the next year to make the public and industry aware of fraudulent health care practices," Secretary Shalala said.

"Fraud alerts put the industry on notice that we are aware of certain abusive practices and that the government will investigate and vigorously seek prosecution," said HHS Inspector General June Gibbs Brown. "The alerts have a powerful and positive impact on industry behavior and provide the industry an opportunity to do a self-examination of its own practices."

The fraud alerts are associated with "Operation Restore Trust," a new initiative to detect fraud and abuse in Medicare and Medicaid, launched by President Clinton and Secretary Shalala in May. Home health services constitute one of the areas to be covered in particular under the "Restore Trust" effort.

Today's fraud alert is aimed at the provision of home health care. Medicare paid almost $16 billion in home health benefits last year in order to allow people with restricted mobility to remain non-institutionalized and receive needed care in the home. Home health service, including physical therapy and intermittent skilled nursing care, are provided when the patient's physician certifies he or she is homebound.

The alert highlights the prevalence of several types of home health care fraud including: (1) cost report frauds; (2) billing for excessive services or services not rendered; (3) use of unlicensed or untrained staff; (4) falsified plans of care; (5) forged physician signatures on plans of care; and (6) kickbacks.

The alert cites examples of violations. In one instance, a home health agency claimed nearly $26 million during one year in visits that were not made, visits to patients that were not homebound, and visits not authorized by a physician.

The alert also cites cost reports that have included costs for entertainment, travel, lobbying, gifts and other expenses unrelated to patient care, including luxury automobiles and cruises.

In addition, the alert says the inspector general has investigated home health agencies which failed to disclose ownership or other relationships with entities with whom they contracted for services. It also covers various forms of illegal payments given in exchange for referral of reimbursable home health services.

Today's alert includes information about how to contact the Office of Inspector General with information about possibly fraudulent activities. This includes the new toll-free line established under "Operation Restore Trust:" 1-800-HHS-TIPS.

The HHS inspector general will continue to issue "Special Fraud Alerts" to heighten awareness of issues of Medicare fraud.

"Fraud committed by health care providers participating in the Medicare and Medicaid programs is a serious problem throughout our nation," Secretary Shalala said. "These alerts help us to respond most effectively to patterns of health care abuse, and they demonstrate the important leadership role of our inspector general in combating health care fraud."

Total federal and state spending on Medicare and Medicaid is estimated to be $328 billion this year.

NOTE: Copies of the "Special Fraud Alert" are available from the OIG Press Office, (202) 619-1142.