Home Health & Hospice Week

Beware this punishing legal tactic.

A lawsuit to challenge a cost report disallowance backfired on Visiting Nurse Association Health Care Services Inc. in Staten Island, NY.

The VNA is paying $1.6 million to settle Medicare fraud charges, according to a release from U.S. Attorney Roslynn Mauskopf.

The government filed False Claims Act countercharges when the VNA brought a federal court lawsuit to recover disallowed aide costs on its 1995 and 1996 cost reports. The agency "improperly included non-Medicare like costs in calculating the costs of home health aide visits," the release says.
 
The government based its FCA charges on claims that the agency included "inflated data and false statements in the cost reports," even though the VNA certified on the reports that it "had followed the applicable standards and that [it] had complied with the cost reporting instructions, despite knowingly and intentionally disregarding them," the release notes.

The settlement also covers potential administrative recoupment claims from 1989 through 1994. And the VNA has agreed to drop related legal action and administrative appeals for 1989 through 2000, Mauskopf says.

• Hospices may have a lot to live up to if the National Quality Forum gets its way. NQF has endorsed "a comprehensive framework for evaluating the quality of palliative and hospice care; a set of 38 preferred practices for delivering high-quality palliative and hospice care; and 9 recommendations for research to improve upon the measurement and evaluation of palliative and hospice care," says a May 18 release.

The hospice quality measures won't become consensus standards like those that the Centers for Medicare & Medicaid Services was required to adopt for Home Health Compare last fall, NQF spokesperson Phil Dunn told Eli at the time the forum proposed the standards (see Eli's HCW, Vol. XV, No. 9).

Parties can request reconsideration of the recommendations via letter by June 19, NQF says. More information is online at www.qualityforum.org/news/prPalliativeendorsed05-18-06.pdf. 

• Members of Congress are working on legislation of interest to home health agencies. Rep. Greg Walden (R-OR), chair of the House Rural Health Care Coalition, has introduced a bill (H.R. 5118) that would extend the 5 percent rural add on for home health agencies through 2011. The legislation also would provide a lump sum payment for rural services provided in the last nine months of 2005--the period after the add on expired and before the Jan. 1 reinstatement by the Deficit Reduction Act of 2005, notes the American Association for Homecare.

And 177 members of Congress asked House Ways and Means Committee and House Energy and Commerce Committee leaders in a May 30 letter to extend the outpatient therapy cap exception process through 2007, according to press reports. A similar letter is circulating in the Senate, the American Physical Therapy Association says. The therapy cap applies only to Part B therapy services, not those furnished under a home health plan of care.

• A bill that aims to temper the impact of competitive bidding on durable medical equipment suppliers continues to gain support in Congress. Introduced on July 28, 2005, by Reps. David Hobson (R-OH) and John Tanner (D-TN), H.R. 3559 now has 114 co-sponsors. AAH continues to encourage stakeholders to contract their members of Congress to sign onto the bill.

• State auditors say Oregon's Seniors and People With Disabilities Division paid out more than $100,000 too much for home care services.

The overpayments occurred when payments continued after the patient had been transferred elsewhere and the hours of service were incorrectly calculated, the Associated Press reports. Auditors also found employees who weren't available 24 hours per day as required by Medicaid rules. Agency officials say they are fixing the problem by identifying providers with outside employment and duplicate and overpayments.

• About 2.8 percent of U.S. adults--one-third of those with diabetes--don't know they have the condition, according to a new study by the National Institutes of Health and the Centers for Disease Control and Prevention.

Type 2 diabetes accounts for virtually all undiagnosed diabetes cases, according to the study published in the June 2006 issue of "Diabetes Care." Nearly 22 percent of people age 65 and older had diabetes, the NIH says in a release about the study.

• Home health mergers and acquisition activity fell off sharply in the first quarter of 2006, according to M&A firm The Braff Group based in Pittsburgh. HHA deals dropped 47 percent from the first quarter of 2005 to nine transactions. Home medical equipment deals fell 48 percent to 14 deals in the same time period.

Deficit Reduction Act cuts, the President's 2007 budget calling for home care cuts and the looming physician reimbursement fix that may result in home care cuts were factors, Braff says in its M&A Market Watch.

• Palmetto Health Hospice in Bluffton, SC will close its doors by June 30, reports The (Hilton Head) Island Packet. The hospice was serving only four patients, who now can choose from the area's other two hospice providers, the newspaper says.