Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies: Hehs-98-29

Pursuant to a congressional request, GAO reviewed how the Health Care Financing Administration (HCFA): (1) controls the entry of home health agencies (HHA) into the Medicare program; (2) ensures that certified HHAs continue to comply with Medicare's conditions of participation and associated standards; and (3) decertifies HHAs that are not complying with Medicare's requirements.

GAO noted that: (1) becoming a Medicare-certified HHA is relatively easy-- probably too easy, given the large number of problem agencies identified in various studies over the past few years; (2) if HHA owners have not been previously barred from Medicare, they can obtain certification without having any health care experience; (3) although such entrepreneurs can hire qualified health care professionals, Medicare's initial certification survey is so limited that it does not provide a sound basis for judging an HHA's ability to provide quality care; (4) although certified HHAs must be periodically recertified, serious deficiencies in the process allow problems to go undetected; (5) HCFA recertifies HHAs by screening them against a subset of the conditions of participation, but when surveyors assessed 44 targeted HHAs against all applicable conditions of participation, almost half had problems serious enough to warrant decertification; (6) many HHAs operate branch offices, but these offices are not subject to the same oversight afforded the parent offices; (7) HHAs are resurveyed every 12 to 36 months, depending on a variety of factors, but rapid growth and high utilization rates, which may indicate potential problem HHAs, are not included among those factors; (8) once certified, HHAs have little reason to fear that they will suffer serious consequences from failing to comply with Medicare's conditions of participation and associated standards; (9) few problem HHAs are terminated from the program; instead they are provided repeated opportunities to correct their deficiencies, even if the same deficiencies recur from one survey to the next; and (10) moreover, HCFA has not implemented a range of penalties to sanction problem HHAs, even though the Congress provided it the authority to do so over 10 years ago.