Home Health & Hospice Week

Hospital transfers, underreported falls, and sparing use of telehealth are highlights.

You can expect to see more enforcement from one federal watchdog agency, if Congress is swayed by its claims.

The HHS Office of Inspector General’s Fall 2023 Semiannual Report to Congress “highlights over $3.44 billion in expected recoveries resulting from HHS-OIG audits and investigations conducted during fiscal year (FY) 2023,” the OIG highlights in a release about the new report. The OIG expects more than $3 billion to be returned based on investigative work while a much more modest $283 million is expected to be returned based on program audit findings, it says.

The OIG reports 707 criminal enforcement in the year ending Sept. 30, and 746 civil actions including “false claims and unjust-enrichment lawsuits … civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters.” The agency also excluded 2,112 individuals and entities from participation in federal health care programs during the year, it adds.

Exclusion is “among the most consequential enforcement authorities available to HHS-OIG,” notes Inspector General Christi Grimm in the report. “The ability to exclude disreputable entities and individuals from participation in Federal health care programs [protects] patients and programs going forward,” Grimm emphasizes.

One of those exclusions was eight years for the owner of a California hospice company. The owner was convicted of accepting payments under the Provider Relief Fund to which they were not entitled, the OIG reports. The owner withdrew payments for personal use and transferred them to another family member. “The court sentenced this individual to nine months incarceration and ordered payment of nearly $150,000 in restitution,” according to the report.

The OIG also mentions an audit it conducted of VITAS Healthcare Corp. of Florida, although it does acknowledge that the Centers for Medicare & Medicaid Services scaled back the disallowed costs in the audit by $2.5 million.

And the OIG celebrates its adopted recommendation to “establish a hospital transfer payment policy for early discharges to hospice care.” That change, which took effect in 2019, has stripped $545 million out of Medicare spending, according to the report.

On the home health side, the OIG highlights a Texas fraud case.

Akintunde Oyewale, owner of home health agency Grace Healthcare Services in Houston, was sentenced to nearly five years in federal prison followed by three years of supervised release and ordered to pay $1.5 million in restitution after being convicted of conspiracy to commit health care fraud.

Oyewale admitted to billing Medicare for home health services that were not medically necessary and not provided; and paying medical clinics illegal kickbacks for fraudulent home health certifications and patient referrals. Oyewale admitted to using the fraudulently obtained funds for personal financial benefit and for the benefit of family members, the OIG reports.

Unreported Falls Dog HHAs

The OIG also reviews its recent reports on HHAs’ unreported falls for patients (see HHHW by AAPC, Vol. XXXII, No. 33) and rare use of telehealth services in the COVID-19 Public Health Emergency (see HHHW by AAPC, Vol. XXXII, No. 35).

The pitch: “Our capacity to achieve high-impact results is limited only by our resources, which have not kept pace with the growth of HHS programs in recent years,” IG Grimm tells Congress in the report. “The additional investment in the Health Care Fraud and Abuse Control Program proposed in the President’s Fiscal Year 2024 Budget would provide critically needed resources to combat fraud, waste, and abuse and enhance efficiency and effectiveness in the Medicare and Medicaid programs,” she argues.

In the budget proposal released last spring, President Biden pitched “$5.2 billion in new mandatory and discre­tionary Health Care Fraud and Abuse Control (HCFAC) resources over the next decade at HHS and the U.S. Department of Justice to address rapidly growing fraud, waste and abuse threats and schemes.”

The funding increase will more than pay for itself, the budget proposal suggested. “These HCFAC investments, plus new legislative authorities to strengthen ... oversight, yield $19.7 billion in savings over 10 years,” it said.

Note: The 116-page report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2023/fall-sar-2023.pdf. The HHS budget proposal is at www.hhs.gov/sites/default/files/fy-2024-budget-in-brief.pdf.