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Home Health & Hospice Week

Industry Notes:

California Fraud Unit Goes After Home Care Providers

Published on Mon Jan 10, 2005

State, feds cooperate in fraud-busting venture.

California home care providers will receive an extra-special dose of fraud scrutiny from now on.

The arrest of the owner of a Long Beach, CA medical equipment supply business represents the "opening salvo" in a stepped-up effort to stop health care fraud in Southern California, according to U.S. Attorney Debra Yang.

Atim Okorn, owner of Pacific Care Medical Supply, has been charged with health care fraud in connection with a scheme in which he allegedly defrauded Medicare of more than $2.4 million for equipment that doctors never prescribed and seniors never received.

"I have formed a new criminal unit that is dedicated to the prosecution of health care fraud, which is unfortunately one of the big 'growth areas' of crime in our district," said Yang, who serves on the Attorney General's Advisory Committee Working Group on Health Care Fraud. The new unit includes agents from the HHS Office of Inspector General and the Federal Bureau of Investigation. 

  • Want to give your two cents on the OASIS burden? The Centers for Medicare & Medicaid Services is soliciting comments on OASIS data use and reporting as part of routine Paperwork Reduction Act requirements, according to the Jan. 25 Federal Register. Interested parties have 60 days to comment on aspects including the accuracy of the estimated burden.
     
    More information is at     www.access.gpo.gov/su_docs/fedreg/a050125c.html. 
     
  • The Scooter Store is fighting for medical equipment suppliers' right to get paid. The nation's largest supplier of power mobility goods has filed suit in federal district court in San Antonio seeking payment from Medicare for 101 power wheelchairs and scooters after the program denied its claims.

    "Even though the Department's actions have produced serious financial challenges for TSS, this is about more than reimbursement to TSS," says TSS attorney Valerie Eastwood. "We are fighting for a fair and predictable process to ensure that patients continue to receive the medically necessary equipment prescribed by their doctors."     
     
  • From now on, when a provider appeals an enrollment decision (such as a denial of enrollment or re-enrollment), the appeal will go to an Administrative Law Judge, CMS says in Jan. 14 Transmittal 95.

    In the past, these appeals went to the carriers. The ALJs, which used to be under the Social Security Administration, are now part of the Department of Health and Human Services, potentially giving HHS more control over their decisions.     
     
  • A beneficiary's signature is always required to submit a Medicare claim, CMS staff reminded providers during the latest Open Door Forum for home care providers. Confusion over signatures has arisen among providers in recent years, as Congress has made available more benefits paid on an assignment-only basis.
     
    There's a section on the Medicare claim form where beneficiaries can indicate that they do or do not assign the benefit; if it's a mandated benefit, the beneficiary does not have to sign that section of the claims form, because assignment will happen automatically.

    However, the assignment signature must be distinguished from the beneficiary signature, which is required on all claims, assigned or unassigned, CMS explained in the forum.
     
  • VistaCare Inc. saw profits plunge but revenues increase in the quarter ended Dec. 31, 2004. The Scottsdale, AZ-based for-profit hospice chain reported net income of $0.7 million on revenues of $56.6 million for the quarter, compared to a $4.7 million profit on $53.6 million in revenues for the same period in 2003.

    VistaCare had to take a $1.5 million charge in the quarter for its Medicare cap exposure, it says. The company is working on reducing Medicare cap overages; average length of stay fell from 130 days a year ago to 114 in the quarter, and median LOS fell from 37 to 31 days in the same period.

    The company opened three new sites in the quarter - two in Georgia and one in New Mexico.     
     
  • Amedisys Inc. looks to be entering the Maryland market next month. North Arundel Hospital in Annapolis, MD plans to sell its home care unit to the regional chain March 1, reports The Capital.

    The hospital sought a buyer because it had a hard time breaking even on the unit, North Arundel told the newspaper. Amedisys has offered jobs to all of North Arundel's 68 home health agency employees.

  • There's one less wheeler-dealer in the Lone Star State. A Texas woman has been convicted of conspiracy to commit health care fraud and receiving kickbacks for her role as a recruiter in a wheelchair scam. Lorine Hawthorne last month pleaded guilty to federal charges in the case.

    According to U.S. Attorney Michael Shelby, Hawthorne in 2002 and 2003 solicited Houston-area Medicare and Medicaid beneficiaries, telling them the programs were providing free scooters and all they had to do to get one was to see a doctor. She then took them to a clinic operated by co-conspirator Dr. Anant Mauskar; there staff performed frivolous tests and Mauskar signed certificates of medical necessity for motorized wheelchairs.

    After receiving the CMNs, Hawthorne sold them to DME companies for between $200 and $500. The indictment alleges that the suppliers would then submit false claims to Medicare and Medicaid indicating they had provided motorized wheelchairs when in fact they had furnished cheaper scooters.

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