Critics see home health care boom in Texas as wasteful spending, but others tout benefits

Irene Anderson cashed in on the home health care boom sweeping Texas. From 2004 to early 2008, Medicare paid her two agencies more than $6.5 million to care for elderly Dallas-area patients.

A federal investigation found that much of the care never was given. This year, Anderson pleaded guilty to defrauding Medicare and was sentenced to 46 months in federal prison and ordered to pay $2.2 million in restitution.

Texas has more home health agencies billing Medicare and more Medicare home health patients than any other state. It also ranks near the bottom in Medicare home health quality ratings and near the top in suspected waste and fraud.

Mary Bell of Dallas relies on home health care workers to help her with her husband, Billy, an Alzheimer’s patient. Texas leads all states in the number of home health agencies billing Medicare and Medicare home health patients. The Anderson case, one of the biggest instances of home health fraud uncovered in recent years, explains in part why. At the same time, hundreds of Texas agencies are providing homebound patients with insulin injections, physical therapy and other care that reduces overall medical costs, health care experts said.

As the struggle to overhaul national health care unfolds, home health is seen as a partial solution to soaring medical costs. But critics portray it as a black hole of wasteful spending.

Medicare spends more on home health in Texas than it does in any other state – an average of $7,761 per home health patient in Texas in 2007, according to the most recent data. That’s 9 percent more than it spent per patient in the next costliest state, Louisiana; 18 percent more than in Florida; and 41 percent more than in California.

A U.S. Government Accountability Office investigation this year found a number of warning signs involving Medicare home health care in Texas. Among them:

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