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 [...]
