Home Health & Hospice Week

One states sees 80% spending spike over 2 years.

As Medicaid spending on home care soars, states are putting agencies under the microscope.

Massachusetts’ crack-down on Medicaid home health agencies is closing agencies’ doors. Earlier this year, the state announced it was taking a number of fraud and abuse-fighting actions after MassHealth spending on home care skyrocketed over 80 percent in just two years (see Eli’s HCW, Vol. XXV, No. 7). As part of the campaign, state auditors found that nine agencies were overpaid $22.5 million (see Eli’s HCW, Vol. XXV, No. 30). Mass-Health cut off payments to Compassionate Homecare Inc. in Worcester earlier this year and to Avenue Homecare Services Inc. in Lawrence in August, reports the Boston Globe. Auditors found Avenue overbilled the state by about $4.6 million.

The state has also filed criminal charges against the Compassionate owner, COO, and administrator, the newspaper says. The state alleges

Compassionate patient records contained forged physician signatures, among other misdeeds. “The charges come after an investigation that began four years ago, after a complaint from a doctor who said Compassionate was trying to provide services through phony referral forms,” the Globe notes.

Meanwhile, many of the seven other HHAs audited complain that sanctions are based on minor technical mistakes, such as entering the wrong address on a form, according to the Globe. HHAs told the newspaper they are disputing the extrapolated overpayment figures. The state released the names of eight of the audited agencies to the Globe, but omitted the ninth agency because its records are part of an ongoing law enforcement investigation.

The largest improper billing figure cited by auditors was Somerville-based Nizhoni Health Systems’ $8.7 million, and the smallest was Methuen-based Comfort Home Care’s $78,000, the Globe reports.

Other Medicaid cases include:

In Ohio: The Ohio Auditor of State office assessed overpayments on two Medicaid agencies last month. Great Nursing Care Inc. in Franklin County owed the state $5.2 million for mistakes such as using aids who didn’t have required certifications and having late-signed or totally missing plans of care, Auditor Dave Yost said in a release. Great Nursing ceased operations.

And P.E. Miller & Associate Inc. in Columbus owes the state about $612,000 for similar problems, Yost said in a separate release.

In Washington, D.C.: A federal judge has ordered Speqtrum Inc. to pay the government $6.15 million in civil damages after the feds won a lawsuit against the Upper Marlboro, Md.-based company in D.C. federal court in February. The judge found that Speqtrum’s conduct was “egregious and willful in its cooking of the books, overbilling for hours not worked, charging … for clients it did not service, and forging physician signatures on its paperwork,” according to the decision, the DOJ says. An OIG/FBI investigation found, among other problems, that “one document contained various practice runs at forging a doctor’s signature —which later appeared in a patient file.”