Home Health & Hospice Week

HHA pays millions in OIG settlement focusing on record-keeping.

In the world of the home health prospective payment system, the old maxim "if it's not documented, it's not done" is more relevant than ever.

And that truism seems to have cost Edina, MN-based home care chain Intrepid USA $8 million. Intrepid spent that much and entered a five-year integrity agreement to settle charges from the HHS Office of Inspector General that it committed a number of documentation-related sins, according to the OIG's latest semiannual report.

The feds alleged that Intrepid and affiliated entities submitted false claims to Medicare, Medicaid, TRICARE and CHAMPUS between February 1997 and October 2004. The claims were for home health services that were not provided by a qualified person, lacked physician orders and plans of care, lacked sufficient documentation of the patient's homebound status, lacked an Outcome Assessment and Information Set evaluation, and/or were improperly coded, the OIG says.

And the government alleged that during January 2002 through June 2003, Intrepid submitted claims to Medicaid for home health services that were not provided.

Intrepid didn't respond to inquiries for this story.

Documentation Review The New Audit

This case "is a perfect example of the growing trend of the government to scrutinize documentation," notes attorney Marie Berliner with Lambeth & Berliner in Austin, TX.

"Twenty years ago, the home health community saw reductions in payments through cost reporting audits and periodic payment reconciliation," Berliner recalls. "Now that home health services are paid under [PPS] where there is less room for interpretation, the emphasis has shifted to the underlying documentation requirements needed to support HHA claims."

Those requirements span a huge array of items--"physician orders to coding issues and everything in between," Berliner stresses.

This settlement highlights "the importance of properly creating and maintaining documentation," notes attorney Robert Markette, Jr. with Gilliland & Caudill in Indianapolis. Scrutiny of documentation problems can start in payor recoupments and quickly progress to survey problems, Markette warns.

Other topics in the semiannual report include:

• A former Louisiana HHA owner was sentenced to 27 months in prison and ordered to pay $2 million in restitution and a $50,000 fine for defrauding Medicare. As part of the scheme, he diverted employees' pension funds and bonuses paid by Medicare for his own personal use--including payments for lawn services at his home and for personal travel expenses.

• The OIG continues to push its recommendation that the Centers for Medicare & Medicaid Services require physicians to examine patients before prescribing home care services for them.

• The OIG reported total fiscal year 2005 savings and expected recoveries of nearly $35.4 billion, more than doubling savings and recoveries since FY 2000. The agency also reported exclusions of 3,806 individuals and entities for fraud or abuse, 537 criminal actions and 262 civil actions.

Note: The OIG report is at www.oig.hhs.gov/publications/docs/semiannual/2005/SemiannualFall05.pdf.