Home Health & Hospice Week

Watchdog agency urges tightening up of hospice bundling.

If you need a reminder of why your agency may be seeing unprecedented scrutiny, look no further than the HHS Office of Inspector General’s Semiannual Report to Congress.

“For every $1 invested in the Health Care Fraud and Abuse Control Program, we recovered more than $4 for taxpayers,” Inspector General Christi Grimm says in the new report to Congress covering October 2021 through March 2022. “We combated fraud through 320 criminal actions and $1.4 billion in expected investigative recoveries,” Grimm adds. “OIG is uncompromising in finding and prosecuting criminals who steal for personal gain at the expense of all Americans.”

The numbers show just how uncompro­mising. “OIG’s investigative work led to … 320 criminal actions during this reporting period,” the report highlights for lawmakers. “OIG also took civil actions, such as assessing monetary penalties against 320 individuals and entities, and excluded 1,043 individuals and entities from Federal health care programs.”

For home health, the OIG zeroes in on the topic of prorating Inpatient Rehab Facility Medicare payments for so-called early discharges to home health. “Medicare could have saved approximately $993 million in [calendar years] 2017 and 2018 if [the Centers for Medicare & Medicaid Services] had expanded its IRF transfer payment policy to apply to early discharges to home health care,” the OIG points out in summarizing a report it issued back in December (see HCW by AAPC, Vol. XXX, No. 45).

The OIG also throws the spotlight on a number of home health fraud cases from the six-month period, including:

• An administrative assistant to home health agency owners received a nearly six-year prison term and was ordered to repay $6.3 million after a federal jury found her guilty of fraud in February 2020. Angelita Newton worked for Care Specialists, a Chicago HHA owned by Ferdinand Echavia and later his wife, Ma Luisa Echavia, the OIG recounts.

Prosecutors showed at trial that about 90 percent of Care Specialists’ patients were not homebound and did not qualify for home care. “Furthermore, many patients received cash bribes to receive home health ‘visits,’ some of which were performed in the visiting nurse’s car,” the OIG highlights. Newton “falsified patient visit records used to support claims,” the report notes.

Newton isn’t the only one behind bars. Ferdinand and Ma Luisa Echavia were sentenced to 84 months and 60 months in prison, respectively, for their roles in the conspiracy, the OIG says. “Another participant in the conspiracy, Reginald Onate, who pleaded guilty and cooperated with the Government throughout the investigation, was sentenced to 3 years’ probation,” the OIG adds.

• After it self-disclosed conduct to OIG, Visiting Nurse Association and Hospice of Vermont and New Hampshire Inc. agreed to pay nearly $2.4 million for allegedly violating the Civil Monetary Penalties Law, the report points out. “OIG alleged that VNH submitted claims for home health services based on orders signed by a qualified clinician but not cosigned by a physician or allowed practitioner,” it says.

Reminder: The OIG updated its self-disclosure protocol last November. It now requires that providers make self-disclosures through the OIG website and increasing minimum amounts to qualify for self-disclosure, among other changes. (See OIG.HHS.GOV/SDP for more changes.) Timelines, content requirements, and damage calculation methodology has not changed, the OIG emphasizes.

• The OIG recounts the recovery of one of its Top 10 Most Wanted Fugitives, who was a former Houston HHA owner.

Background: Ebong Aloysius Tilong pleaded guilty in 2017 in two separate cases, after being indicted on charges relating to a scheme run through Fiango Home Health Care Inc. In the $13 million fraud scam, Tilong and his wife and Fiango co-owner Marie Neba paid kickbacks to physicians, patient recruiters and patients themselves, prosecutors said. And they falsified medical records to make it appear patients qualified for and received home care services when they did not. After Neba was convicted at trial and sentenced to an astonishing 75 years in prison, Tilong “removed an ankle bracelet monitoring his location” and failed to appear for sentencing in October 2017, fleeing to Cameroon. He was sentenced to 80 years in prison in absentia that December.

Last December, Tilong “was extradited from the Republic of Cameroon to the United States to serve an 80-year prison sentence,” the report says. He had been under arrest since 2019 there.

Nonhospice Pay On The Rise

The pressure to enforce hospice bundling also appears in the report.

The OIG reviews a February 2022 report in which it noted that “nonhospice payments for Medicare Part A services and Part B items and services totaled $6.6 billion from 2010 through 2019.” That’s an increase, and “suggest[s] the need for increased oversight,” the OIG tells Congress. “If providers bill Medicare for nonhospice items and services that potentially should be covered by hospices, Medicare could pay for the same items or services twice,” it warns. (See more details about the report in HCW by AAPC, Vol. XXXI, No. 7.)

And in a November 2021 report, the OIG assessed that Medicare improperly paid Durable Medical Equipment, Prosthetics, Orthotics, and Supplies suppliers an estimated $117 million over four years for DMEPOS. In 121 of 200 sampled pieces of DMEPOS, the “items should have been provided directly by the hospices or under arrangements between the hospices and the suppliers,” the watchdog agency said. (See more details about the report in HCW by AAPC, Vol. XXX, No. 43.)

Note: The 93-page Semiannual Report is at https://oig.hhs. gov/reports-and-publications/archives/semiannual/2022/2022-spring-sar.pdf.