关键词：医疗补助;声称;补偿;支付;医疗保健服务;医疗保险
摘 要：To strengthen the integrity of Medicares home health benefit, the Balanced Budget Act (BBA) of 1997 established a surety bond requirement for HHAs. The surety bond requirement is an important program integrity tool that provides a sentinel effect of keeping fraudulent providers out of the program and a means for Medicare to guarantee recoupment of some overpayments. However, the BBA requirement remains unimplemented after nearly 15 years. In the years since enactment of the BBA of 1997, the home health benefit has remained highly vulnerable to fraud. In recent years, numerous individuals were indicted on charges of fraudulently billing Medicare for millions in home health services. In addition, the number of HHAs and the amount of home health care expenditures have increased since 1997. Not using the surety bond as a program integrity tool leaves Medicare at risk for losing millions of dollars in overpayments to HHAs. Medicare covers home health services for beneficiaries who need part-time or intermittent care. Home health care services include skilled nursing services, physical or occupational therapy, speech therapy, medical social services, and home health aide services. To qualify for home health services, Medicare beneficiaries must be: homebound (i.e., confined to the home); in need of home health care services on a part-time or intermittent basis; under a physicians care; and under a plan of care established and reviewed periodically by a physician. As of 2011, a physician must also certify through a face-to-face encounter that a beneficiary needs home health services. This encounter must occur no more than 90 days before or 30 days after services begin.