Problem provider’: There’s that term again
The U.S. General Accounting Office recently released yet another report bemoaning the Health Care Financing Administration’s seeming inability to weed "problem providers" out of the Medicare program. In the GAO’s report to the U.S. Senate’s Special Committee on Aging, titled Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Providers, the agency reports that "becoming a Medicare-certified home health agency is relatively easy probably too easy, given the large number of problem agencies identified in various studies over the past few years."
It goes on to fault HCFA’s initial certification surveys as so limited that they cannot provide a sound basis for judging an agency’s ability to provide quality care.
The recertification process is also deficient for the following reasons, according to the GAO:
• HCFA recertifies agencies by screening them against a small subset of the conditions of participation, but when 44 agencies were assessed against all applicable COPs, almost half of them had problems serious enough to warrant decertification.
• Many agencies have branch offices that are not subject to the same oversight as the parent office.
• Rapid growth and high utilization rates are not included in the factors that determine the frequency of survey.
• Problem agencies have repeated opportunities to correct deficiencies, even if the same ones recur from survey to survey.
• HCFA has not implemented a range of penalties to sanction problem agencies, even though Congress provided it authority to do so more than 10 years ago.
For these reasons, the GAO reports that "home health agencies have little reason to fear that they will suffer serious consequences from failing to comply with Medicare’s conditions of participation and associated standards."
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