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Therapists who treat nursing home residents are dramatically overcharging Medicare, in one case billing $206 for doing nothing more than delivering a toothbrush, federal auditors contend.

The General Accounting Office investigation couldn't determine exactly how much Medicare overpays each year. But its auditors uncovered numerous examples of overbilling, including speech therapists who charged the government 24 times their true salaries and a company that charged $450 to test a 98-year-old's hearing.The problems stem from a 1990 federal law that forced nursing homes to offer occupational, physical or speech therapies to any potentially eligible patient, the GAO said in a report released Wednesday. Sixty percent of nursing home residents now receive some therapy.

The costs were expected to rise some as patients began receiving needed care, the GAO noted. But it investigated therapists' billing practices at the request of Rep. John Dingell, D-Mich., who was concerned that those bills had tripled - to $3 billion a year - since 1990.

The findings "suggest the problem is national in scope and growing in magnitude," concluded the GAO, Congress' investigative arm. "Significant regulatory changes will be required to enable (the government) to purchase rehabilitation services prudently."

The GAO said the Health Care Financing Administration, which administers Medicare, should set limits on therapy bills and require proof that the therapy actually was given and given properly.

Among the problems the agency found:

- States list speech therapist salaries at about $25 an hour, yet the HCFA reports bills of $150 for a 15-minute visit, or $600 an hour.

- The HCFA was billed $2,550 for speech therapy for a 95-year-old North Carolina woman whose daughter says couldn't have been helped because she is physically incapable of communicating.

- A stroke victim's wife discovered that occupational therapists billed the HCFA $206 every time they entered the man's room, even to simply deliver him a new toothbrush.

- A Georgia clerk who handled Medicare bills for two therapy companies added 80 percent to the bills to cover his fee. Another therapist added $170,000 to his Medicare reimbursements over six months by creating a sham billing company that requested similar paperwork markups.