Home Health & Hospice Week

Authorities are throwing the book at fraudulent medical equipment suppliers, and the results are stiff prison sentences.

Case No. 1: Enohor Akarue, former owner of Rosewood Medical Supplies in Houston, received a 15-year prison sentence after pleading guilty to theft in relation to a wheelchair billing scheme, according to Texas Attorney General Greg Abbott.

In 2002 and 2003, Akarue billed Medicare and Medicaid for devices never provided, Abbott says. He also billed the programs for expensive wheelchairs when he actually provided cheaper scooters. "The suspected overpayments to Akarue by Medicare are $564,000, with another $53,500 coming from Medicaid," Abbott notes in a release.

"To save taxpayer dollars and protect Texas seniors, Attorney General Abbott has dramatically expanded [the] MFCU," the release adds.

Case No. 2: Angela Isley, former chief operating officer for Orthoscript Inc. in Alpharetta, GA, received a five-year-and-10-month prison sentence after a jury convicted her of health care fraud, mail fraud and money laundering, says U.S. Attorney David Nahmias. Isley also must pay restitution and fines totaling nearly $825,000.

Isley was convicted of upcoding wrist braces and walking boots as custom-made items when they were prefabricated, off-the-shelf devices, Nahmias says in a release. Orthoscript overbilled Medicare by $600,000 based on the upcodes, which Isley directed employees to submit despite their protests.

Isley was also convicted of embezzlement. She used $360,000 of the company's money to pay off her personal credit cards, the release says.

Don't just stand by: Arch Nelson, who was a partner in Orthoscript, drew five years of probation and 250 hours of community service for knowing about but failing to report Isley's crimes.

"Today's action sends a message to those who corruptly take advantage of the Medicare system," says OIG Special Agent in Charge Melody Jackson in the release. "The Office of Inspector General ... will continue to work aggressively to eliminate this type of corruption."

• It appears home health agencies won't be ignored under Quality Improvement Organiza-tions' upcoming 9th Scope of Work after all. The Centers for Medicare & Medicaid Services earlier indicated that QIOs would dramatically scale back their HHA assistance in the next cycle of their contract (see Eli's HCW, Vol. XVII, No. 14, p. 112).

But now CMS says it will launch a new Home Health Quality Campaign under the 9th Scope of Work, according to the National Association for Home Care & Hospice. "The exact nature and extent of new campaign activities under the next SOW was not revealed since QIOs will engage in a competitive bidding process for the home health contract," NAHC says in its newsletter for members.

• Providers shouldn't have to face drastic proposals for Medicare cuts any time soon. Late last month, the House of Representatives voted to delay President Bush's Medicare trigger bill.

Because Medicare has taken more than 45 percent of its funding from the government's "general revenue," President Bush is legally able to propose a way to cut Medicare spending. This would essentially allow the president to pull a "trigger" that allows him to reduce overall Medicare spending or increase beneficiaries' premiums.

The House vote ensures that the trigger bill will not take effect this year. Congress members note that the MIPPA legislation, passed in July, decreases Medicare spending so that the 45 percent threshold will not be met, which means that the trigger won't be necessary anyway.

Department of Health and Human Ser-vices Secretary Mike Leavitt disagreed with the House action, noting, "Democrat House leadership is now actively seeking to silence the alarm bells and prevent any action to address Medicare's underlying solvency problems."

• If you rely on patients' Medicare cards to cross-check their Medicare and Social Security numbers, you may soon have to change your ways.

Rep. Lloyd Doggett (D-TX) recently introduced legislation, H.R. 6600, that would take SSNs off Medicare cards. The bill, titled the "Medicare Identity Theft Prevention Act of 2008," aims to safeguard beneficiaries' identity information.

• You can start familiarizing yourself with the new ICD-9 coding guidelines effective Oct. 1. CMS and the National Center for Health Statistics within the Centers for Disease Control have posted the updated guidelines, which contain instructions on how to use the new and revised codes.

The 119-page guidance is at www.cdc.gov/nchs/datawh/ftpserv/ftpICD9/ftpICD9.htm. To sign up for a Sept. 13 Eli audioconference by coding ex-pert Judy Adams reviewing the new codes, go to http://www.audioeducator.com or call 1-800-508-2582.

• Home care providers often complain that the outcomes-based quality improvement standard on emergent care is largely out of their control, and some new findings may back up that argument.

The number of emergency department visits in the U.S. increased by 36 percent to 119 million in 2006, as compared to 90 million in 1996, according to a recent CDC report on hospital use. Of every 100 Medicaid beneficiaries, 82 used ED care in 2006, compared to 21 of every 100 people with private insurance, the report says.

Infants had the highest use of EDs of any age group, but people older than 75 were the second-highest users of ED care, the report found. The report is online at http://www.cdc.gov/nchs.

• Get ready for yet another PPS Pricer update. "If you use the HH PPS PC Pricer, please go to [ http://www.cms.hhs.gov/PCPricer/05_HH.asp ] and download the latest version of the PC Pricer," CMS says in a message to providers.

• If you're a California home care provider served by National Government Services, you'd better get your billing details straight. "Home health and hospice providers submitting batch claim files to National Government Services MUST change the Receiver ID/Contractor number in ANSI 837I files from 00454 to 00456," NGS instructs on its Web site. "This value is located in the ISA08 segment and in the GS03 segment."

NGS will reject claims with the old Recei-ver ID/Contractor number, NGS warns. Providers will also see a new menu selection on Direct Data Entry (DDE) related to the change, the regional home health intermediary says.

• You may see increased demand for CPAPs, thanks to a new study. Continuous positive airway pressure therapy improves endothelial-dependent and endothelial-independent vasodilatation in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), according to a report in the July issue of Thorax.

"These important and novel findings suggest that vascular dysfunction is related to disease severity in OSAHS, and that effective treatment with CPAP can improve vascular function and consequently reduce the associated cardiovascular complications," the researchers say in the study.

• New York home health agencies may be facing a painful double whammy. Gov. David Paterson (D) has proposed steep funding cuts for home care, along with other providers like nursing homes and hospitals. The cuts would total about $90 million for HHAs, notes the Home Care Associa-tion of New York State.

"Any effort to balance the state's finances must not be done on the backs of seniors and disabled New Yorkers who rely on home health care services," says HCA's Joanne Cunningham in a release. The proposed cuts "could destabilize New York's fragile home and community-based health care system -- a system that is already subject to enormous cost pressures, including the expense of staff recruitment and retention efforts, exorbitant fuel prices for travel to patients' homes, and the costs of treating and managing increasingly complex patient care needs."

And the massive union representing home care aides, 1199 S.E.I.U., is seeking legislation from the state that would raise mandated pay levels for aides. The union is threatening a strike if aides don't see a pay increase, according to The New York Times.

• Regional chain Almost Family Inc. is touting its latest earnings. The Louisville, KY-based company reported net income of $3.9 million on revenues of $48.7 million for the quarter ended June 30. That's a big increase from the $2.0 million profit on $32.5 million in revenues it reported for the same period in 2007.

Revenues for its visiting nurse segment grew from $23.5 million to $38.9 million during that period, the company notes in a release. Almost Family focuses most of its efforts on the VN business line, CEO William Yarmuth says.