Home Health & Hospice Week

Terminated agency stays terminated.

Sometimes there are no second chances. High Tech Home Health in Davie, FL has learned that lesson the hard way.

The HHS Departmental Appeals Board has shot down an appeal requesting the DAB to require the Centers for Medicare & Medicaid Services to re-survey the terminated home health agency, according to a decision released last month (Doc. No.: C-05-351, Decision No. CR1482).

CMS terminated High Tech's provider agreement after Florida Agency for Health Care Administration surveyors surveyed the agency in February of 2005 and found it substantially out of compliance with eight conditions of participation.

The laundry list of deficiencies included failing to follow a written plan of care, failing to document verbal orders and failure to have a qualified registered nurse supervising personnel, according to the DAB decision.

After the February survey, High Tech submitted a plan of correction that said it would be in compliance by March 10. When Florida surveyors re-surveyed the agency on March 23, they found the agency still out of compliance with five COPs.

The agency admitted "the March 23 survey caught [it] in a transition phase in both personnel and automation in which [it] was admittedly in non-compliance," the decision noted. High Tech insisted it had corrected the problems by April 8 and needed a new survey.

The DAP sided with CMS, saying no further survey was required and that CMS was within its rights to terminate the provider agreement rather than impose less harsh sanctions as an intermediate step.

• You'd better take a hard look at your laptop policies. A stolen laptop is once again creating privacy headaches for a home care provider. A thief took from a nurse's car a laptop computer containing patient information, including home addresses and social security numbers, for 14,000 patients of Allina Hospitals & Clinics OB home care program, reports the Minneapolis Star Tribune.

Minneapolis-based Allina is offering free credit monitoring services to its patients, the newspaper reports. The health system doubts the information has been accessed because doing so requires two passwords, a spokesperson told the Tribune.

• Palmetto GBA will serve as the competitive bidding contractor for durable medical equipment, prosthetics, orthotics and supplies competitive bidding program, the Centers for Medicare & Medicaid Services announced Oct. 22. For more information, go to www.cms.hhs.gov/CompetitiveAcqforDMEPOS/05_CBIC_Contractor.asp.

• If your denial codes look unfamiliar, you're not alone. Regional home health intermediary Cahaba GBA implemented new denial codes starting Oct. 1, the RHHI says on its Web site. Cahaba cut the number of codes from 226 to 22 for home health PPS and from 41 to 10 for hospice.

In the new five-digit codes, the first character is always a "5" and the second character is an "H" for HH PPS or a "P" for hospice. The third through the fifth characters are letters and identify the type of denial.

Providers can access the denial reason code definitions through the Fiscal Intermediary Standard System (FISS) by pressing "F1" while in the Claims Entry or Claims Correction screens (MAP1711) of FISS, or by selecting "17" from the Inquiry Menu, Cahaba instructs.

• Watch out for faulty remittance advices. HHAs served by Palmetto may have received incomplete RAs for Oct. 4 through Oct. 17 due to a software glitch. The intermediary will provide regenerated RAs upon request when they're available, it says on its Web site.

• Don't be so sure of your wage index for this year if you're a hospice. CMS issued corrections to its 2007 wage indices, which use core-based statistical areas (CBSAs) for the second year, at www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1535cn_correction.pdf.

• A registered nurse who formerly owned the two largest HHAs in California has pleaded guilty to defrauding Medicare of $40 million and filing false tax returns, U.S. Attorney Debra Wong Yang says in a release.

Lourdes "Lulu" Perez owned and operated Provident Home Health Care Services Inc. in Los Angeles and Tri-Regional Home Health Care Inc. in San Dimas.

According to information unsealed last month, Perez and people working with her defrauded Medicare by paying illegal kickbacks for referrals, billing for patients who weren't homebound and didn't medically need home health services, billing for services not rendered, and creating false medical records to support the fraudulent claims, the release says.

Former Provident director of nursing Margaret Tan also is pleading guilty in the case.

The charges resulted from a payroll clerk at Provident, Marietta Diaz, filing a whistleblower lawsuit against Perez, the release notes. Medicare suspended payments to Provident and Tri-Regional in October 2003. The government has recovered nearly $34 million from Perez and Diaz received more than 20 percent of the settlement.

• Lincare Holdings announced net earnings of $56.2 million on revenues of $358.0 million for the quarter ending Sept. 30, compared to a $53.9 million profit on revenues of $320.1 million for the third quarter of 2005.

Lincare, a Clearwater, FL-based provider of oxygen and other respiratory therapy services delivered to patients in the home, said the 12 percent increase to revenues was comprised of 13 percent internal growth partially offset by a 3 percent reduction in Medicare pricing, and a 2 percent contribution from acquisitions.

• Home health agency mergers and acquisitions are staying lively. LHC Group Inc. is entering the Florida market by acquiring for undisclosed terms the assets of Lifeline Home Health Care in that state, according to a release from LHC. They are located in Lakeland, Ocala, Sebring, Marathon, Sarasota, Port Charlotte and The Villages.

The Lafayette, LA-based regional chain acquired Lifeline's Kentucky assets in August (see Eli's HCW, Vol. XV, No. 24).

Sun City, AZ-based Sun Health Corp. has signed an agreement with Hospice of Arizona to provide services at Sun Health's two hospice facilities in the West Valley, reports The Business Journal of Phoenix. Sun Health also is in discussions with an unnamed home care provider to handle its home health business.

And Almost Family Inc. has bought Camellia Home Health in Fort Lauderdale and Palm Beach, FL for undisclosed terms, the company says in a release. Almost Family operates 59 locations in seven states.

• Akron, OH-based Cambridge Home Health Care has opened its twenty-fifth office in the state in Marietta. The company serves more than 2,100 patients with more than 1,600 staff.