Home Health & Hospice Week

Medicare to target agencies with higher M0175 adjustments.

The HHS Office of Inspector General is keeping M0175 on the front burner.

In its latest semiannual report to Congress, the OIG recaps its reports on the OASIS item regarding prior inpatient stays, emphasizing that home health agencies improperly coded the question on all 400 claims sampled.

Medicare overpaid HHAs $48 million in fiscal years 2002 and 2003 based on incorrect M0175 answers, the OIG estimates (see Eli's HCW, Vol. XV, No. 14). The report fails to mention the amount that Medicare owes back to agencies for underpayments made in Medicare's favor.

Beware: In response to the report, the Centers for Medicare & Medicaid Services agreed to "develop data analysis techniques to identify [HHAs] with significant numbers of claims rejected or adjusted by the new [M0175] payment controls, and then to subject those agencies to corrective action," the OIG notes.

The report is at www.oig.hhs.gov/publications/docs/semiannual/2006/SemiannualSpring2006.pdf.

• The OIG also profiles two home care-related fraud cases in its latest semiannual report to Congress.

Interim HealthCare of Wyoming Inc., Interim HealthCare of Southern Wyoming Inc. and the agencies' owner agreed to pay $250,000 to resolve allegations that Interim submitted claims for Medicare services that weren't provided as claimed and/or were false or fraudulent, the OIG announces. Interim Health-Care and its owner agreed to enter into five-year Cor-porate and Individual Integrity Agreements.

Also, the former co-owner and CFO allegedly claimed his salary in cost report years 1994 through 1998 when he actually was employed full time elsewhere, the OIG says. In a separate settlement agreement, the former CFO agreed to pay $20,000 and to permanent exclusion from Medicare.

Finally, a Colorado RN was excluded from Medicare for at least 60 years following a conviction for causing the death of a home care patient under her care. The nurse also used the patient's credit card to obtain cash and make purchases, the OIG says.

The RN was ordered to serve a life sentence without parole for first-degree homicide, was sentenced to 30 years for aggravated robbery against an at-risk adult, six years for theft, and three years for unauthorized use of a credit card.

• Home care providers should be more leery than ever of potential legislative cuts to Medicare reimbursement rates for 2007 and later.

Republicans aren't eager to open up Medicare legislation this session, at least before November midterm elections. But a range of lawmakers are enthusiastic about eliminating the Medicare physician rate cut that is pending, probably in a session after elections, reports The Hill.

Like last year, legislators are considering home care spending as a funding source for the estimated $10 billion physician fix, congressional insiders say. Mem-bers of Congress are also considering eliminating the outpatient therapy caps, at a cost of $500 million, according to the newspaper.

• Medical oxygen therapy would continue to be covered by Medicare as a continuous rental under a bill introduced into Congress May 25.

The Deficit Reduction Act of 2005 shifted medical oxygen therapy from a continuous rental benefit under Medicare to a rent-to-purchase (capped rental) model, with a requirement that ownership of equipment transfer to the beneficiary after 36 months.

Rep. Joe Schwarz (R-MI), a physician, introduced the bill, the Home Oxygen Patient Protection Act (H.R. 5513).

• Regional home health intermediary Palmetto GBA is getting ready to make Deficit Reduction Act-related adjustments. "The adjustments will affect TOB 3XI," Palmetto explains on its Web site. "Providers will see a remark on page four of DDE stating it is a DRA adjustment."

The adjustments will undergo normal claims edits, Palmetto adds. Providers that need to correct adjusted claims will be subject to the usual timely filing guidelines. The DRA retroactively reduced regular home care rates and increased rural rates in February.

• Home care providers accredited by the Joint Commission on Accreditation of Healthcare Organizations have a few more items to add to their to-do lists. JCAHO added two requirements to its 2007 National Patient Safety Goals that will affect home care providers, the Oakbrook Terrace, IL-based accrediting body says in a release.

Under the goal "the organization identifies safety risks inherent in its patient population," home care organizations must identify risks associated with long-term oxygen therapy, such as home fires, the Joint Commission says.

And in new language under the existing medication reconciliation goal, providers must issue a complete list of current medications to the patient upon discharge from care. More information on the goals is at www.jointcommission.org/PatientSafety.

• Lincare Holdings Inc. has agreed to pay $526,000 to end a federal whistleblower lawsuit. The suit claimed three of the company's Massachusetts facilities overbilled Medicare between January 1999 and March 2004, according to U.S. Attorney Michael J. Sullivan.

The company, based in Clearwater, FL, admits no wrongdoing according to the terms of the settlement, which was announced June 8. This announcement comes on the heels of Lincare's $12 million settlement with the OIG in May over kickback and other allegations (see Eli's HCW, Vol. XV, No. 19).

• Physicians could make it harder for you to vaccinate seniors and others against the flu.

At a June 12 meeting, the American Medical Association considered proposals to limit flu vaccine access for visiting nurse associations and other community immunizers, the Visiting Nurse Associations of America notes in a release. VNAA urged the AMA reps at the meeting not to adopt the resolutions.

The proposals would cause AMA to seek legislation enforcing distribution to physicians first while restricting public clinics' access, VNAA says. VNAs furnished 3 million flu shots last season, according to the trade group.