Home Health & Hospice Week

Watchdog agency lists millions in fraud settlements from the last six months.

The feds want some things to change in home care, the HHS Office of Inspector General indicates in a new report.

In its latest semiannual report to Congress, which the watchdog agency issues every six months, the OIG revisits its findings from a February report taking the Centers for Medicare & Medicaid Ser-vices to task for not having stricter OASIS data submission standards (see Eli's HCW, Vol. XXI, No. 9, p. 66). "HHAs did not properly submit required OASIS data for 6 percent of claims filed in 2009, which represented over $1 billion in Medicare payments," the semiannual report emphasizes to Congress. "CMS should identify all HHAs that failed to submit OASIS data and apply its 2 percent payment reduction authority," among other measures, the OIG urges.

Watch out: CMS appears to already have heeded this suggestion from the OIG. In a transmittal released earlier this month, CMS tells contractors to dock agencies pay rates by 2 percent if they don't meet OASIS and HH CAHPS data submission requirements, including submitting OASIS data "for all episodes" (see Eli's HCW, Vol. XXI, No. 19, p. 151). The transmittal's implementation and effective dates are Aug. 13.

The OIG also restates a suggestion from a March report on intermediate sanctions (see Eli's HCW, Vol. XXI, No. 10, p. 78). "CMS should make HHA intermediate sanctions a high priority and complete their implementation as soon as possible," the OIG tells Congress.

And the OIG reiterates findings from a March report on documentation (see Eli's HCW, Vol. XXI, No. 11, p. 84). The agency actually found that only 2 percent of claims it reviewed failed to meet Medicare coverage criteria.

But "home health is an area at increased risk for fraud" and CMS needs to go beyond paper record reviews, the OIG urges. And the review found 22 percent of claims billed in error.

The OIG lists multiple guilty pleas and fraud settlements involving home care providers around the nation. For example, in the Miami area individuals affiliated with ABC Home Health and Florida Home Health saw stiff prison sentences and orders to repay funds in restitution.

And the OIG touts the indictment of Dr. Jacques Roy and five HHA owners in the Dallas area for nearly $375 million in Medicare fraud. The OIG also notes the 78 HHAs with payment suspensions related to Dr. Roy and other physicians from his practice.

Hospice Focus: High Level Care

The OIG doesn't leave hospices out of the fraud and abuse spotlight. Although the OIG didn't issue hospice-specific reports in the last six months, it did make a few settlements.

For example: In a high-profile settlement with for-profit hospice chain Odyssey Healthcare Inc., now owned by Gentiva Health Services Inc., Odyssey agreed to pay $25 million to resolve allegations that it submitted claims for unnecessary continuous care services from 2006 to 2009.

And Hospice Home Care Inc. in Arkansas agreed to pay $2.7 million for allegedly billing for General Inpatient (GIP) care when the patients received only routine care.

Note: See the OIG's semiannual report at http://oig.hhs.gov/reports-and-publications/semiannual/index.asp. Links to the transmittal and MLN Matters article regarding OASIS data are at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2466CP.html.