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www.southernsenior.info 5 Home Health Fraud Sponsored by EqHealth Solutions Medicare covers most home health services that are considered “reasonable and necessary” for the treatment of an illness or injury usually after a hospital stay. The home health agency must be deemed Medicare-certified. Home Health agencies work with your doctor to evaluate your health care needs and tell you what home care services you need. To be eligible for these services, your doctor must certify that you are homebound. Some of the services that are covered by Medicare are: · Skilled nursing care on a part-time or intermittent basis and must be performed by a registered nurse or a licensed practical nurse. · Physical therapy, speech therapy and occupational therapy. · Home health aide services on a part-time or intermittent basis to assist you with things such as bathing, using the toilet or dressing. Medicare will not pay for anyone to assist you with household chores such as vacuuming or washing clothes. · Durable medical equipment such as walkers, wheelchairs, or bedside commodes. · Certain medical supplies, like wound care dressings that are ordered as part of your care. In general, most home health agencies are honest and use correct billing information. Unfortunately, fraud does occur. Examples of home health fraud include billing for visits that were not made, billing for equipment and supplies that were not received, and billing for equipment and supplies that were not needed. Your local SMP is ready to provide you with the information you need to PROTECT yourself from Medicare errors, fraud, and abuse; DETECT potential errors, fraud, and abuse; and REPORT your concerns. SMPs use trained senior volunteers to help educate and empower seniors in the fight against health care fraud. Your SMP can help you with questions, concerns or complaints about potential fraud and abuse issues. SMP also provides information and educational presentations. This project was supported by a grant (Nos. 90MPPG0049, 90MPPG0024 & 90MPPG0023), from the U.S. Administration for Community Living, Depart- ment of Health and Human Services, Washington, D.C. 20201. Grantees un- dertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, there- fore, necessarily represent official Administration for Community Living policy S