Home Care Agencies Often Wrongly Deny Medicare Help to the Chronically Ill

Although Medicare covers home care services for qualifying persons, incentives intended to combat fraud and reward high-quality care are causing some home health agencies to refuse to help chronically ill persons, reports Kaiser Health News . "We feel Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes," said Kathleen Holt with the Center for Medicare Advocacy. Under federal law, Medicare must pay indefinitely for home care, with no copayments or deductibles, if a doctor ordered it and beneficiaries are unable to leave home. Obtaining Medicare coverage for home health services demands persistence, says John Gillespie, whose mother has ALS. "You have to have a good doctor and people who will help fight for you to get the right company," he notes. "Do not take no for an answer." The National Association for Home Care and Hospice argues Medicare's home health care policies are often misconstrued. "One of the myths in Medicare is that chronically ill individuals are not qualified for coverage," says association president William Dombi. He notes part of the problem is that some agencies are afraid they will not get paid if they take on people who need their services for prolonged periods. This can draw the attention of Medicare auditors who can refuse payments if they think the beneficiary is ineligible or they suspect billing fraud.