Home Health & Hospice Week

The feds have three billion good reasons to continue their fraud-fighting campaign against home care and other medical care providers. The HHS Office of Inspector General expects to recover $3 billion in federal monies due to audits and investigations in the first half of fiscal year 2010, it says in its latest semiannual report to Congress. The OIG also reported exclusions of 1,935 individuals and entities from participating in Federal health care programs, 293 criminal actions, and 164 civil actions.

More crackdowns ahead: "We have aggressively pursued new avenues of enforcement and are actively developing our operational strategy to successfully meet our growing oversight responsibilities," Inspector General Daniel Levinson says in a release about the new report. The report highlights problems with home health agency outlier payments in Miami Dade county and other areas. Aside from the high-profile outlier fraud and abuse in Miami Dade county, the OIG also found aberrant outlier billing in 23 other counties nationwide, it says.

Stats: More than 85 percent of HHAs that received more than $100,000 per beneficiary in outlier payments in 2008 were in Miami Dade, the OIG notes. And 67 percent of agencies receiving more than $1 million in total outlier payments were in the county.

The Centers for Medicare & Medicaid

Services has instituted a 10 percent outlier cap to combat this problem, the OIG acknowledged. For durable medical equipment suppliers, the OIG focused on problems with support surface claims using GA or GZ modifiers. CMS may have inappropriately paid $4.4 million for such claims in 2007, the OIG says.

Suppliers may not be using appropriate modifiers when furnishing upgrades and Medicare may be paying for more than one support surface per beneficiary or higher-priced support surfaces than necessary, the OIG claims.

The OIG also highlighted a fraud case where an oxygen company owner received a sentence of a year-and-a-half jail time and $200,000 in restitution. Jeffrey McElveen, owner of Positive Home Oxygen in Louisiana, allegedly billed Medicare for power wheelchairs that were unnecessary. The company was ordered to pay more than $800,000 in restitution and was permanently excluded from Medicare.

The company's medical director, Dr. Robert Cleveland, received three months' home detention and was ordered to pay $200,000 in restitution for signing certificates of medical necessity for the chairs in exchange for referrals to his practice and cash, according to the OIG.

The report is online at www.oig.hhs.gov/publications/docs/semiannual/2010/semiannual_spring2010.pdf.