Home Health & Hospice Week

HHA owner fugitive is apprehended at the border.

Home health may not get mentioned in the new HHS Office of Inspector General Semiannual Report as much as in previous editions, but what the report lacks in quantity is made up in excess.

For example: The Semiannual Report to Congress, which covers Oct.1, 2019, though March 30, 2020, cites the case of Rodolfo and Marta Pichardo, owners of “at least” six home health agencies in the Miami area. The Pichardos were convicted on fraud charges related to a $38 million scheme and sentenced last December to more than 23 years in prison.

The Pichardos paid kickbacks to patient recruiters for home health referrals, and kickbacks to physician practice owners and operators for bogus home health prescriptions. They used the proceeds for items ranging from cosmetic surgery to fancy cards to vacations (see Eli’s HCW, Vol. XXIX, No. 1).

Another example: Federal authorities re­cently apprehended a former HHA owner convicted of fraud who was one of the OIG’s “Most Wanted Fugitives.” After Alejandro Diaz Gonzalez became the owner of Humanly Home Health Care Agency in 2014, the agency’s billing spiked, more than tripling to $856,478.47 in March 2015.“A large percentage of beneficiaries identified in these claims reside outside the service area for Humanly, and nu­merous complaints were received regarding services not rendered,” according to the report.

Gonzalez pleaded guilty to billing for services not rendered in November 2019 and was sentenced to 2.5 years in prison and ordered to pay $1.3 million in restitution, the OIG says. But after absconding to Cuba, “he was recently apprehended by authorities attempting to re-enter the United States through the Arizona border,” the report says.

On the hospice side, the OIG didn’t include specific fraud cases. But it did review its November 2019 report, “Registered Nurses Did Not Always Visit Medicare Beneficiaries’ Homes at Least Once Every 14 Days To Assess the Quality of Care and Services Provided by Hospice Aides.”

Medicare hospice conditions of participation require RNs to conduct aide supervisory visits every 14 days, when aide services are ordered.RNs must document the visits in the clinical record, the Conditions of Participation say. Also, aides don’t need to be present during the supervisory visits.

The OIG audited about 189,000 “high-risk” RN visit date pairs in 2016 that were more than 14 days apart. Based on reviews of 78 claims from that pool, the OIG estimates that with 99,000 of the date-pairs (52.4 percent), RNs did not make supervisory visits as required. And with another 5,000 of the date-pairs (2.6 percent), RNs didn’t document the supervisory visits sufficiently (see more about the report in Eli’s HCW, Vol. XXVIII, No. 43).

CMS agreed with the OIG’s recommen­dations, including working with state survey agencies and accreditation organizations to increase emphasis on the requirement.

The report also briefly mentions the August 2019 report, “Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit” (see Eli’s HCW, Vol. XXVIII, No. 30).

Note: The report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2020/2020-spring-sar.pdf.