Home Health & Hospice Week

The co-owner of a former HHA faces a 10-year sentence in federal prison for defrauding Medicare of more than $2.9 million, according to the U.S. Attorney’s Office in the Northern District of Illinois. Bahir Haj Khalil was the co-owner of House Call Physicians LLC, an HHA based in Palos Hills, IL.

Khalil’s sentencing follows his September 2012 conviction at trial on six counts of healthcare fraud. He is the last of three co-defendants to receive his sentence. The federal district judge presiding over the case imposed the maximum sentence.

But Khalil’s misfortune doesn’t end there -- he is a native of Syria and a Canadian citizen who was not authorized to work in the United States. After finishing out his prison sentence, Khalil will face deportation.

• Beware of this LUPA glitch for high therapy episodes. If you want to receive the roughly $95 you’re owed for a LUPA add-on amount when high-therapy cases end before five visits, you’ll need to submit manual adjustments -- at least for a while. So says the National Association for Home Care & Hospice.

Currently, when an agency predicts 20 or more therapy visits but the episode ends up being a low utilization payment adjustment with four or fewer visits, the system isn’t including the LUPA add-on that agencies should earn in addition to the per-visit payment amount. For an episode’s HIPPS code, "the current PPS Pricer does not recognize ‘5’ as eligible for LUPA add-on payments and does not autocorrect when an episode qualifies as a LUPA," NAHC explains in its member newsletter.

Unfortunately, it may be a while before CMS can correct the problem. It’s too late to fix the problem in the January pricer update, and another update may not come until January 2014 if there are no other problems to correct.

Meanwhile: "To receive the LUPA add-on, home health agencies must cancel and resubmit any early episode claims that projected 20 or more therapy visits that resulted in a LUPA," NAHC instructs. "Resubmitted claims should be assigned a HHRG for low therapy, early episode with a ‘1’ as the first digit in the HHRG," as opposed to a high-therapy HHRG that starts with "5."