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Home Health & Hospice Week

Industry Notes:

Enteral Nutrition Sting Ropes In Another Guilty Plea

Published on Thu Jan 13, 2005

Supplier excluded from Medicare.

A man has pleaded guilty to violating anti-kickback laws after being nabbed by an undercover federal operation.
 
Under "Operation Headwaters," the feds have reeled in 10 guilty plea convictions and more than $600 million from providers and manufacturers in the enteral nutrition business. The Federal Bureau of Investigations and other federal agents set up "Southern Medical Distributors" in 2000 as part of a sting operation to catch fraudulent suppliers in an industry-wide probe.
 
In the latest case, Brian Denny pleaded guilty Friday to the felony charge in U.S. District Court in East St. Louis, according to the Associated Press. Prosecutors allege Denny defrauded Medicare by using false, misleading and fraudulent documents to conceal and misrepresent the purchase prices of feeding tubes, pumps and liquid food, AP says.
 
Denny agreed to be excluded from participation with Medicare for 10 years, and he has agreed to help with the prosecution of others, reports the Belleville News-Democrat. He also faces up to five years imprisonment and a $25,000 fine.

 

  • The Centers for Medicare & Medicaid Services has held steady on its deadline for requiring hospitals to publish their home care referral statistics. Unfortunately, that deadline was already a ways off.
     
    In its June 2004 semiannual regulatory agenda, CMS pushed back the date for a final rule regarding the statistics to November 2005 (see Eli's HCW, Vol. XIII, No. 25, p. 194). In its December agenda, CMS maintains that date.
     
    Experts say they wouldn't be surprised if the date gets pushed back even further in the next agenda. However, if the final rule isn't published by Nov. 22, it will exceed the new three-year publication time limit and will have to be re-proposed, CMS notes.
     
    Home health agencies hope making hospitals' referral statistics public will discourage hospitals from steering patients to their own HHAs or other agencies.

     

  • Home care providers won't have to wrestle with new diagnosis codes this April. Although the ICD-9 committee now has the ability to revise codes every six months, there were no requests for April updates, CMS says on its coding Web site. "All those requesting new or revised codes elected to have the new codes implemented on October 1, 2005," CMS notes.

     

  • The competitive bidding Program Advis-ory and Oversight Committee will face a host of topics in its next meeting, slated for Feb. 28 - March 2. Payment issues, considerations for small suppliers, data collection and quality standards are all on the agenda recently posted at www.cms.hhs.gov/suppliers/dmepos/ compbid/tentative_topics.pdf. Interested parties must register to attend the meeting by Feb. 18.

     

  • The Joint Commission on Accreditation of Healthcare Organizations is revamping its medical abbreviation rules. JCAHO convened a summit on errors caused by misused abbreviations, which was attended by 50 professional societies and associations, the Oakbrook Terrace, IL-based accrediting body says.
     
    JCAHO plans to adopt some summit proposals, but in the meantime it has reduced its National Patient Safety Goal 2b to clarify that it applies "only to all orders and all medication-related documents." More information is online at     www.jcaho.org/About+Us/News+Letters/JCAHOnline/jo_01_05.htm#summit.

     

  • Louisville, KY-based Morrland Holdings has sold two Texas home health agencies to Dallas-based AHM Advanced Homecare Management Inc., reports Business First of Louisville.
     
    On Dec. 1, 2004, Morrland sold Hallmark Homecare in San Antonio and Lifeway Home Health in Austin in a deal financed by private merchant bank Saunders Karp and Megrue and Bank of Paribas, the newspaper says.
     
    "Hallmark Homecare and Lifeway Home Health ... have experienced substantial growth throughout the five years of my ownership," Dean Holland, Morrland president and CEO, says in a release. "For those agencies to achieve that 'next level,' they required the financial backing of a firm with the resources available to AHM."

     

  • A turf war has begun after a hospice catering to African-American and low-income patients proposed plans to open a location in Nashville, TN.
     
    Mahogany Hospice Care Inc.'s opening is opposed by Alive Hospice and Priority Hospice Care, reports the Nashville Business Journal. The parties have filed letters with the Tennessee Health Services and Development Agency.
     
    The existing Nashville hospices say there is no need for a new hospice provider, but Mahogany says the needs of under-65 African-Americans haven't been met. Owner Tony Suggs sold a Memphis Mahogany Hospice Care operation to Odyssey HealthCare for $1.3 million in 2003, the paper says.
     
    The proposed hospice would serve about 20 patients, generating more than $800,000 in revenue this year and $1.2 million in 2006, the Journal reports. It would rely on Medicare for half of its patients, Tennessee's Medicaid program for 20 percent and private pay for 30 percent.
     
     
  • Matria Healthcare Inc. is undergoing changes. The Marietta, GA-based disease management provider reorganized itself into a holding company structure "to provide ... a more flexible capital structure and to allow for an organizational structure that is more closely aligned with Matria's business operations," it says in a release.
     
    The former Matria Healthcare Inc. changed its name to Matria Women's and Children's Health Inc. and is now a wholly-owned subsidiary of the holding company. Matria's Board of Directors also declared a three-for-two stock split.
     
  • In light of recent flu vaccine shortages, your elderly patients may be interested in new financial assistance for antiviral medicines.
     
    Although CMS says there is an adequate vaccine supply for seniors, the agency has announced a demonstration project that will cover antiviral prescription drugs - with particular interest paid to Part-B beneficiaries who do not have drug coverage
     
    The demo, which lasts through May 31, will allow beneficiaries to fill two prescriptions of amantadine, rimantadine, oseltamivir or zanamivir at a Medi-care-participating pharmacy. If the beneficiary has met her Part B deductible, Medicare will pay 80 percent of the drug's cost up to the Medicare allowed payment - 95 percent of the average wholesale price for brand drugs and 90 percent of AWP for generics.
     
    Patients who participate in the drug discount card program will pay 20 percent of the card sponsor's cost.
     
    Medicare Advantage plan members and beneficiaries who are treated as part of a covered Part A hospital stay will also be covered.
     
    "The flu vaccine remains the best protection for Medicare beneficiaries," CMS said in a release.
               
    For information about flu antiviral meds, including dosage and approved persons for use, go to www.cdc.gov/flu/professionals/treatment.

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