Home Health & Hospice Week
TX Fraud Headed To Trial
Four men accused of home health fraud have pleaded not guilty and will face trial in January, the Brownsville Herald reports — including the mayor of a south Texas town. And authorities have arrested a fifth man in the case. Reminder: In January, the government alleged a fraud conspiracy involving more than $150 million in false Medicare claims, in which Merida Health Care Group owner Rodney Mesquias and managers Henry McInnis and Jose Garza “caused kickbacks and bribes to be paid to medical directors, including [Francisco] Pena … in exchange for certifying that patients qualified for services when, in fact, they did not, and for referring patients for such services,” the Department of Justice said. “Mesquias, McInnis, Garza, and Pena also fraudulently kept patients on hospice services for multiple years in order to increase revenue from Medicare” (see more case details in Eli’s HCW, Vol. XXVII, No. 4). In addition to laundering money, “Mesquias and McInnis used proceeds derived from the scheme to purchase expensive vehicles such as a Porsche, expensive jewelry, luxury clothing from high-end retailers such as Louis Vuitton, exclusive real estate and season tickets for premium seating to see the San Antonio Spurs,” according to a DOJ release. Pena is also accused of taking a kickback from a “confidential source” (CS) and then giving a false statement to the FBI about it, as well as directing the CS to lie to the FBI about any cash kickbacks. Mesquias and McInnis also “allegedly instructed their co-conspirators to manufacture false records ... to obstruct the grand jury’s investigation,” the DOJ added. Plus: “During the course of the investigation, Pena allegedly told a cooperating witness that, with respect to hospice patients, ‘the way you make money is by keeping them alive as long as possible,’” the DOJ said. The feds arrested a fifth man, Jesus Virlar-Cadena, in the scheme on Oct. 18, the Herald says. Rio Bravo mayor Pena had his medical license suspended in March, reports KGNS.tv in Laredo.
Home Health & Hospice Week
- Prospective Payment System:
2019 Rate Increase Largest In More Than A Decade
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CMS Hangs Onto Behavioral Assumption Adjustment Cuts, Despite Industry Outcry
Industry needs Congress’ help. While the Patient-Driven Groupings Model is supposed to be a [...] - OASIS:
Focus On These 8 PDGM-Impacting OASIS Items
Accuracy will be paramount. These OASIS items will make up PDGM functional levels: M1800: Grooming.
[...] - Finance:
New Clinical Groups Complicate PDGM Impact Estimation
The payment reform plan contains a whopping 432 case mix groups. Trying to figure out [...] - Patient-Driven Groupings Model:
Find A Patient's PDGM Case Mix Group With These 4 Steps
MMTA expansion also affects comorbidity groups. While some of the details have changed, the case [...] - Billing:
PPS Rule Finalizes First Step Of RAP Elimination
New HHAs no longer will receive RAP payments under PDGM. Despite many strident industry comments [...] - Billing:
Eliminated RAPs May Lead To Notice Of Admission Requirement
Beware possible penalties for late NOAs. Home health agencies don’t like the idea of implementing [...] - Regulations:
Ready Or Not, 30-Day Billing Periods Are On The Way
Medicare officials claim switch won’t increase burden. It’s no surprise that the Patient-Driven Groupings Model [...] - Hospice:
Use NOTRs To Head Off Missed Reimbursement
Beware the edit that prevents NOEs for some readmissions. To make sure you don’t miss [...] - Industry Note:
Burdensome Discharge Planning Reg Still Looms
CMS puts reg off at least a year. Home health agencies have one less regulatory [...] - Industry Note:
Commemorate National Home Care, Hospice Month
It’s not too late to celebrate Home Health and Hospice month with your staff, referral [...] - Industry Note:
MAC Holds RCD Calls
Review Choice Demonstration contractor Palmetto GBA has started monthly calls aimed at updating affected providers [...] - Industry Note:
TX Fraud Headed To Trial
Four men accused of home health fraud have pleaded not guilty and will face trial [...]
