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Home Health & Hospice Week

Industry Notes:

DME WHISTLEBLOWER STRIKES OUT

Published on Tue May 13, 2003

Not every whistleblower case against a home care provider is successful, no matter what it may seem like.

Case in point: A former employee of a durable medical equipment company - and veteran whistleblower, with two successful suits behind him - recently tried to sue DME regional carrier AdminaStar Federal Inc. for "recklessly" approving claims for non-reimbursable adult diapers that were disguised as other, covered items. Federal judges, however, nixed his case in trial court, and again on appeal.

The problem: Whistleblower Richard Feingold based his case on publicly available documents, including fraud alerts issued directly by the Department of Health and Human Services, a newspaper article, court papers and a Centers for Medicare & Medicaid Services (then known as the Health Care Financing Administration) statistical analysis of improper claims.

All of those documents, the 7th U.S. Circuit Court of Appeals ruled in U.S. ex rel Feingold v. AdminaStar Federal Inc. (No. 01-3806), were readily available to the public, albeit not necessarily widely disseminated. Thus Feingold brought little or nothing to the case, and wasn't eligible to keep his False Claims Act suit rolling.

  • Home care providers would be unlikely to fare well under suggestions for reforming Medicare put forth by the General Accounting Office in testimony before the Joint Economic Committee. Increasing the deductible for Part B and instituting other copayments would help improve Medicare's financial future, GAO Comptroller David Walker testified April 10.

    Walker also excoriated home health agency payment rates under the prospective payment system as overly generous - 35 percent more than HHA costs in the first six months of 2001, he claimed. And Walker lambasted oxygen suppliers, charging that Medicare paid more than $500 million more than "another public payor" for home oxygen equipment.

  • The U.S. House and Senate have approved a $2.2 trillion budget resolution for fiscal year 2004 that does not include the earlier proposed Medicaid cuts of nearly $100 billion, according to press reports. The budget blueprint includes President Bush's request for $400 billion for Medicare reform including a prescription drug benefit.

  • Home medical equipment suppliers should heed a warning about SARS and nebu-lizers. Aerosolized medication treatments, such as furnishing albuterol via a nebulizer, may facilitate the transmission of severe acute respiratory syndrome, the Centers for Disease Control and Prevention warns in a release.

    Home care providers should evaluate patients for SARS before initiating such aerosol-generating procedures, perform them on SARS patients only when medically necessary, and take appropriate precautions when administering such procedures, the CDC says.

    More information is online at www.cdc.gov/ncidod/sars/aerosolinfectioncontrol.htm.

  • Avoiding prohibited abbreviations is the hardest patient safety goal for JCAHO-accredited providers to comply with, the Joint Commission on Accreditation of Healthcare Organizations reports. In the 313 surveys assessing compliance with the goals completed as of Feb. 21, 7 percent of organizations failed to comply with the abbreviations mandate, JCAHO says.

  • If you downloaded CMS' OASIS patient tally report workbook when it first was available, you'd better go back and download it again. The original version gives incorrect results if no cases meet the data filtering criteria, CMS explains. The revised workbook is at www.cms.hhs.gov/oasis/obqi.asp. The Excel tool helps agencies mine their data for outcome-based quality improvement use.

  • CMS has issued a bevy of new K codes for surgical dressings (K0620-K0621), dialysis supplies (K0610-K0614), speech generating devices (K0615-K0617), automatic defibrillators and supplies (K0606-K0609), and thoracic lumbar sac-ral othoses (K0618-K0619), according to CMS program memoranda AB-03-043, AB-03-044 and AB-03-045, issued April 11.

  • DMERCs must pay claims for DeWall Posture Protector Orthotic Body Jackets (L0430) if they are received with a "WL" and "KX" modifier, CMS says in April 11 program memo B-03-025. Although the U.S. District Court for the District of Nebraska has ordered CMS and the DMERCs to pay for the items, the HCPCS Alpha Numeric Editorial Panel deleted code L0430 as of March 31, 2003. Thus, DMERCs must process claims for the items with the appropriate modifiers to comply with the court's injunction, CMS instructs.

  • A Tennessee court has ordered Almost Family Inc. to pay almost $1 million in damages for stock registration problems. But the Louisville, KY-based home care and adult day services provider plans to appeal the decision, it says.

    Franklin Capital Associates charged in a lawsuit that Almost Family "failed to use its best efforts to register shares held by Franklin as required in connection" to a home health acquisition, according to the company. The Tennessee court dismissed the suit's claims of fraud against Almost Family, but ruled in favor of Franklin with respect to its breach of contract action, the company says.

  • Air Products has inked a five-year contract with AmeriNet, a group purchasing organization based in St. Louis, to furnish medical grade oxygen to the organization's Northeast and Southeast members through 2008, the Lehigh Valley, PA-based gas and chemical company says.

  • Home care providers served by regional home health intermediary Palmetto GBA soon will receive record requests from somebody new. TriCenturion, the Program Safeguard Contractor formed by Medicare contractors Palmetto, First Coast Service Options and TrailBlazer Health Enterprises, in January assumed many fraud and abuse-fighting activities formerly performed by Palmetto, the RHHI says.

    TriCenturion validates claims payments made to Medicare providers and therefore will sometimes request medical and claims records from home care providers. "Providers should respond to TriCenturion's inquiries with the same manner of cooperation that was afforded to Palmetto GBA," the RHHI instructs.

     

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