Home Health & Hospice Week

Home health ‘ripe for corrective action,’ federal watch dog says.

Scrutiny of the home health industry isn’t likely to let up any time soon, judging from recent actions from federal authorities.

In a May 24 hearing before the House Energy & Commerce Subcommittee on Oversight and Investigations, HHS Assistant Inspector General Ann Maxwell pointed the finger at home health agencies for fraudulent activity. In 2015, “HHS reported that the improper payment rate for home health care claims increased to 59 percent,” up 7.57 percent since the last reporting period, said Maxwell in the hearing, “Medicare and Medicaid Program Integrity: Com batting Improper Payments and Ineligible Providers.”

“Considering this statistic, and the results of prior [HHS Office of Inspector General] work, home health care is an area ripe for corrective action and reducing improper payments,” Maxwell told legislators in prepared testimony. “In fact, we have audits underway to determine whether home health agencies across the country complied with Medicare requirements.”

Here are the latest examples of enforcement activities against home health providers:

• A home health patient recruiter has received a five-year prison sentence for taking kickbacks for referrals, the Department of Justice says in a release. Carlos Rodriguez Nerey, owner of Nerey Professional Services Inc. in Miami, was also ordered to pay $2.4 million in restitution. According to evidence presented at trial, from October 2014 to September 2015, Nerey was involved in a conspiracy to accept kickbacks in return for referring Medicare beneficiaries to Mercy Home Care Inc. and D&D&D Home Health Care Inc., including those who did not qualify for Medicare home care. He contributed to the submission of $2 million in fraudulent claims to Medicare, the DOJ says.
• Two Washington, D.C. Medicaid home health agency owners have drawn lengthy sentences after being found guilty of Medicaid fraud and related charges last November (see Eli’s HCW, Vol. XXIV, No. 41). Global Healthcare Inc. owner Florence Bikundi was sentenced to 10 years in prison and her husband and co-owner Michael Bikundi Sr. received seven years in prison, the DOJ says in a release. The judge also ordered the Bikundis to pay $80.6 million in restitution to D.C. Medicaid, among other fines and penalties. Earlier in the case, the cou- ple was ordered to forfeit more than $11 million seized from 76 bank accounts; their residence, worth about $1 million; $73,000 in cash seized from their residence; and five luxury vehicles with a total purchase price of more than $400,000, the release adds. Seven others, many of them Florence Bikundi’s relatives, pled guilty in the case. Two were indicted and are now fugitives, the DOJ notes.
• The OIG trotted out a number of home health enforcement examples in its latest semiannual report to Congress. They included two convicts in the fraud case surrounding Advance Home Health Care Services Inc. in Detroit. Advance manager Jaweed Mohammed was sentenced to two years in prison and ordered to pay $1.4 million in restitution in a kickbacks and false claims scheme, while Advance owner Amer Ehsan received more than six years in prison and $4.6 million in restitution. Seven defendants in the scheme have been sentenced to a combined 25 years in prison and ordered to pay a total of $13.6 million in restitution.
• Medicaid home health also got attention in the OIG semiannual report. It listed the case of Ohio Heritage Home Health Agency owner Sharon Ward, who used the identity of another nurse with the same name to hide the fact that she was unlicensed and had been excluded from Medicaid. Her mother, Queen Ward, was the Heritage office manager and pled guilty to fraud. Queen Ward was ordered to pay nearly half a million dollars in restitution after creating false background check reports for Heritage employees who were disqualified from working as home health aides due to their felony criminal convictions, the OIG notes.
• And the OIG highlighted its self-disclosure protocol. Community Health United Home Care in Mississippi agreed to pay $9.8 million to resolve its liability for conduct it self-disclosed to OIG, the report notes. “Specifically, OIG alleged that, from January 1, 2008, through February 29, 2012, CHUHC submitted claims for hospice services at Center Home Care Corporation and Fallbrook Home Care Services without certifications of terminal illness, face-to-face encounters, and/or physician narratives, as required by hospice regulations,” according to the report.

Note: See Maxwell’s congressional hearing testimony at http://oig.hhs.gov/testimony/docs/2016/maxwell-testimony05242016.pdf and the OIG semiannual report at http://oig.hhs.gov/reportsandpublications/archives/semiannual/2016/SAR_Spring_2016.pdf.