Advanced Search

Home Health & Hospice Week

Industry Notes:

Fraud Watchdog Charges Ahead On Excessive Charges Guidance

Published on Fri Sep 19, 2003

Durable medical equipment suppliers confused about how much is too much when it comes to charge-based Medicare payments could soon get some guidance from the HHS Office of Inspector General.

In a Sept. 15 Federal Register notice, the OIG says it's planning to clarify the regulations that govern when it can exclude a provider from Medicare and other federal health care programs for billing for amounts that are substantially in excess of that provider's usual charges - even if the charges are based on a fee schedule.

The proposal includes a formula that defines "usual charges" as well as a bright line for "substantially in excess" that's set at 120 percent of usual charges. The watchdog agency invites comments on the proposal, which are due Nov. 14.

The exclusion rule would primarily affect providers of Part B items, including DME, supplies and drugs. It could also play into outlier enforcement - a current OIG hot button.

The rule is at www.access.gpo.gov/su_docs/fedreg/a030915c.html.

  • If you've had a Joint Commission on Accreditation of Healthcare Organizations survey recently, you know that abbreviations are high on the accrediting body's list of no-nos. "Surveys conducted during the first six months of this year show that this goal has the highest level of non-compliance among all of the [National Patient Safety Goal] requirements," JCAHO says in a recent online newsletter.

    But many providers are in the dark on exactly which abbreviations are taboo. Now the Oakbrook Terrace, IL-based accreditor is developing "a list of commonly misunderstood abbreviations, acronyms and symbols and a corresponding list of preferred terms in order to provide additional guidance for organizational compliance with National Patient Safety Goal 2b," the Joint Commission says. The list will go on its Web site later this year.

  • Kentucky is the latest state to jump on the AWP lawsuit bandwagon. Kentucky Attorney General Ben Chandler has filed a lawsuit against five pharmaceutical companies - Illinois-based Abbott Laboratories, California-based Dey and three related New Jersey-based companies, Schering-Plough, Schering and Warrick Pharmaceutical - for inflated average wholesale prices for drugs. Chandler expects to seek more than $100 million in the suit to recover Medicaid losses due to the allegedly fraudulent pricing, reports the Lexington Herald-Leader.

  • Home care providers wondering what in the world Centers for Medicare & Medicaid Services chief Tom Scully is thinking may have an opportunity to find out. Scully is scheduled to speak at the Visiting Nurse Associations of America's Regulatory and Legislative Conference Sept. 24. VNAA has opened its conference, which will feature other CMS officials and will follow VNAA's Sept. 23 Lobby Day, to all comers. Registration and additional information are at www.vnaa.org.

  • New Mexico's Medicaid home care program soon may put utilization limits on its Personal Care Option, reports the New Mexico Business Weekly. The personal care services program, begun in 2000, was expected to grow to $10 million in spending by 2003. Instead, it has grown to $150 million and is the fastest-growing part of the Medicaid program, says the state's Human Services Department.

    HSD is researching how to slow the growth of the program, which served 8,774 people with an average of 116 hours per month last year, says the newspaper. The program has contributed to lower nursing home enrollment, the state says.

  • A consumer-directed home care program is being launched in South Carolina. "S.C. Choice" will pay for home care services furnished by friends, relatives and neighbors, reports the Associated Press. The Medicaid program will pilot in three counties this year, then expand statewide in 2004.

  • Odyssey HealthCare Inc., a Dallas-based for-profit hospice chain, expects its patient census to hit 6,500 during the month of September. That includes 315 patients from recent acquisitions, Odyssey says.

  • It appears lenders won't be wresting control of American HomePatient Inc. from shareholders any time soon. The U.S. District Court for the Middle District of Tennessee rejected an appeal from AHP's secured lenders that sought to give control of the company to them under its bankruptcy reorganization plan (see pdf of Eli's HCW, Vol. XII, No. 24, p. 192). AHP emerged from bankruptcy in July.

    If the lenders appeal that decision to the U.S. Sixth Circuit Appeals Court, the company will "vigorously defend the confirmation order entered by the Bankruptcy Court and upheld by the District Court," it says.

  • The Phoenix Group Corp.'s bankruptcy reorganization plan has been approved by its creditors and the U.S. Bankruptcy Court for the Northern District of Texas, Fort Worth Division, the Dallas-based home care consolidator says. Phoenix filed bankruptcy last year after Edina, MN-based Intrepid USA Health Care Services tried to take control of Phoenix subsidiary InterLink Home Health Care Inc. (see pdf of Eli's HCW, Vol. XI, No. 29, p. 239). Phoenix plans to return to its original business plan of acquiring home care businesses and related organizations, it says.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All