Home Health & Hospice Week

Patient recruiters and kickbacks feature in fraud enforcement actions.

You may feel like all the high profile fraud busts in the home care arena give the industry a bad name, but the feds claim they are actually cleaning up the industry.

“Medicare payment trends demonstrate the positive impact of [HEAT] Strike Force enforcement and prevention efforts,” says the HHS Office of In-spector General in its recent annual report on Health Care Fraud and Abuse Control in 2014.

For example: “Medicare payments for home health care increased from 2006 until 2010,” the OIG notes. But following the HEAT Strike Force crackdown in the Miami area, “since 2010, Medi-care payments for home health care nationally de-creased by more than $300 million per quarter (or more than $1 billion annually),” the OIG celebrates.

Specifically, in Miami, payments for HHAs decreased by $100 million per quarter since the peak in 2009; in Dallas and McAllen, Texas, payments for HHAs are down by $30 million per quarter; while in Detroit, payments for HHAs decreased by $25 million per quarter since peak in 2009.

Conclusion: “This may suggest that the home health fraud convictions not only eliminated some of the ‘bad actors,’ but also deterred other fraudsters from exploiting the outlier coverage policy,” the OIG says.

The OIG trots out a long list of home health-related busts it conducted last year, including guilty pleas and convictions for cases involved with Trust Care Health Services Inc., Anna Nursing Services Corp., LTC Home Care Professionals Inc., Professional Home Care Solutions Inc., and Merfi Corp. in Miami; multiple unnamed agencies in Detroit; PTM Healthcare Services Inc. in Texas, and Passages Hospice in Illinois. Most of the cases involved patient recruiters, physician kickbacks, and medically unnecessary or never-provided services, amongst other violations.

The OIG also lists non-Strike Force actions against Caring Nurse Home Health Corp., Good Quality Home Health Inc., and Flores Home Health Care Inc. in Miami; Jackson Home Healthcare Inc., Prestige Health Services Inc., Houston Compas-sionate Care Inc., and Texas Comprehensive Healthcare Resources Inc. in Texas; and unnamed agencies in Detroit. Many of the cases involved a physical therapy focus and patient recruiters.

The OIG singles hospices out for attention this year too. In addition to Passages, the report highlights cases against Hospice of the Comforter Inc. in Altamonte Springs, Fla., Hospice Compas-sus in Brentwood, Tenn., and Home Care Hospice Inc. in Pittsburgh. The cases generally focused on ineligible patients and upcoding service levels.

Don’t expect the feds to let up any time soon. “The field offices develop solutions to the most challenging program integrity issues in their region,” the OIG says. “In Miami, for example, the field office has boots on the ground working to root out fraud in home health by performing provider and beneficiary interviews. This has resulted in 105 revocations from the Miami Field office for FY 2014.” 

Note: You can read more details about the cases in the report online at http://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf.