Home Health & Hospice Week

The going remains tough for health care providers who rub Medicare and Medicaid fraud fighters the wrong way.

For the fourth government fiscal year in a row, more than 3,000 individuals and organizations were excluded from federal health care programs, according to the HHS Office of Inspector Gen-eral's latest semiannual report. The OIG also boasts 576 convictions for fraud and other misconduct, up from 517 last year, and 243 new civil suits under the False Claims Act and other laws, up from 236 in 2002.

The monetary haul from fraud investigations in 2003 was $988 million - down significantly from the $1.49 billion secured in 2002. On the other hand, the OIG says the total amount it saved the government through fraud probes, audits, and cost-saving recommendations reached a record $23 billion in 2003.

The OIG boasts of the $2.9 million settlement with Poudre Valley Health Care Inc. in Colorado. The health system allegedly inflated costs on cost reports and failed to disclose related party transactions between its home health agencies (see Eli's HCW, Vol. XII, No. 18, p. 141).

The watchdog agency also touted three settlements with durable medical equipment suppliers - $14.8 million in restitution for a Florida supplier fraudulently billing Medicare and Medicaid and laundering the proceeds through offshore bank accounts; 46 months in prison and $1.4 million in restitution for a Texas salesperson of diabetic shoes who forged physician names on certificates of medical necessity; and two Alabama DME owners excluded from Medicare with a $30,000 settlement for defrauding Medicare by forging physician signatures at a "documentation party," among other misdeeds.

In the report, the OIG reiterates its recommendation that the Centers for Medicare & Medicaid Services recoup payments when agencies fail to mark on OASIS item M0175 when a patient had a hospital stay within 14 days of admission.