Home Health & Hospice Week

Physicians will have to examine every single patient before certifying them for home care, if the HHS Office of Inspector General gets its way.

Requiring an exam before ordering services is the lone home health agency policy change the OIG recommends in its latest semiannual report, where it summarizes its activities from October 2002 to March 2003. An OIG review found "unallowable [home care] services continued to be provided because of inadequate physician involvement," the report says.

Imposing such a rule would mean unnecessary costs for the Medicare program and needless delays for seniors who require home care services, notes Erik Sokol with the National Association for Home Care & Hospice. Since severe penalties for physicians who incorrectly certify patients for home care already are in place, this measure is "a waste of resources," Sokol says.

Doc Exams A Waste of Resourses 

HHAs can feel fairly secure that the Centers for Medicare & Medicaid Services shares their view on the matter. The OIG has repeatedly proposed this requirement to no avail. "It's the same old song," Sokol points out.

CMS doesn't want to pay docs for those unnecessary visits any more than agencies want to wait on an exam to begin services, expects attorney John Gilliland with Indianapolis-based Gilliland & Caudill.

HHAs should be pleased they received relatively little ink in the OIG's report, indicating that the fraud watchdog has let up some on its harassment of the once-beleaguered industry. In the mid to late 1990s, in the Operation Restore Trust era, the OIG's reports were filled with HHA recommendations and examples.

"The OIG seems to be focused more on other segments of the health care industry these days, including the HME industry," says Burtonsville, MD-based health care attorney Elizabeth Hogue. (For more on the OIG's home medical equipment focus, see related story, "Compliance:  PHYSICIAN ORDERS, KICKBACKS DOG SUPPLIERS").

The OIG has pointed its investigations elsewhere for a number of reasons (see "HHAs HAVE LOST THEIR APPEAL AS FRAUD TARGETS").

With HHA-related fraud and abuse enforcement on the wane, agencies have turned their attention from compliance to more immediate concerns - generally reimbursement issues and quality of care. Those issues aren't "black and white, and thus do not make for 'smoking gun' OIG reports touting large cost savings," observes former CMS official Bob Wardwell, now with the Visiting Nurse Associations of America.

But agencies may be in for a rude surprise if they neglect compliance matters, warns Hogue. "Agencies don't seem to be updating compliance plans to reflect PPS and new materials" from the OIG, she worries.

"Reimbursement and quality-related issues are inextricably intertwined with fraud and abuse issues," she reminds HHAs. "Providers ignore either side of the 'equation' at their peril."

Editor's Note: The semiannual report is at http://oig.hhs.gov/publications/semiannual.html.