Home Health & Hospice Week

HHS wants in excess of a billion dollars to combat Medicare fraud next year.

Look for more fraud patrol efforts coming from the nation's capital.

On July 18, Department of Health and Human Services Secretary Mike Leavitt told the House budget committee that the Bush administration would seek additional funding for fiscal year 2008 to combat Medicare fraud--to the tune of $1.3 billion for that year alone.

The goal is to secure funding for a program jointly operated by HHS and the Department of Justice to coordinate federal, state and local law enforcement efforts to reduce fraud in Medicare.

In a new move, HHS said that the administration hopes to revise current law to allow some of the funds recovered in fraud investigations to go toward efforts to address fraud. Current law directs that all funds recovered in fraud investigations go back to the Medicare trust fund.

• You'd better make sure your HIPAA policies and procedures are up to snuff. The feds may be getting more serious about investigating potential HIPAA violations.

In addition to the HHS Office of Inspector General conducting its first HIPAA security rule audit this spring (see Eli's HCW, Vol. XVI, No. 15), the Department of Health and Human Services has granted subpoena power to the HHS Office for Civil Rights. OCR is in charge of HIPAA enforcement.

The authority covers "subpoenas in investigations of alleged violations of the HIPAA Privacy Rule and of the Patient Safety and Quality Improvement Act of 2005," the HHS OCR Web site notes.

• Provider enrollment may get even more arduous thanks to a new transmittal.

Providers have 60 days to respond to a pre-screening letter requesting information and documentation. "If the contractor makes a follow-up request for information, the 60-day clock does not start anew," the Centers for Medicare & Medicaid Services emphasizes in June 29 Transmittal No. 214 (CR 5504).

"Rather, it keeps running from the date the pre-screening letter was sent." The contractor can, at its discretion, extend the time clock if the provider is working toward compliance, CMS adds.

Supplier revocations fast-tracked: Revocations issued by a contractor other than the National Supplier Clearinghouse become effective within 30 days of the initial revocation notification, CMS says. NSC revocations are effective 15 days after the entity is sent notice of the revocation.

Program Safeguard Contractors and CMS satellite and regional offices can initiate revocations by going through the Division of Provider and Supplier Enrollment, the transmittal adds. You can read the transmittal online at  www.cms.hhs.gov/transmittals/downloads/R214PI.pdf.

• There's a good reason you're struggling so hard with emergent care outcomes. A recent study found older adults have an emergency medical services utilization rate four times that of younger patients.

According to a study published in the journal Academic Emergency Medicine, researchers found: 38 percent of EMS responses were for senior patients (age 65 or older) between 1997 and 2000; 62.2 million older adults visited the emergency department during that same three-year period; and 167 older adults per 1,000 was the average rate of EMS utilization per year, compared to a rate of 39 per 1,000 for younger patients.

EMS utilization will only increase with increased volumes of older patients, the study warned.

• Almost a quarter of claims for negative-pressure wound therapy pumps didn't meet Medicare coverage criteria, according to a new report from the HHS Office of Inspector General (OEI-02-05-00370). Medicare spent $21 million in 2004 on medically unnecessary wound therapy, the report claims.

• Regional home health intermediary Palmetto GBA has rewritten its Local Coverage Determination on Hospice ALS and wants your comments. You can submit feedback on the LCD, which Palmetto has revised "to incorporate the concepts of Going Beyond Diagnosis," by Aug. 27, Palmetto says on its Web site.

• Investment firm Flexpoint Partners has acquired a majority interest in Grapevine, TX-based IntegraCare Home Health, The Braff Group says in a release. The Pittsburgh-based mergers and acquisitions firm brokered the deal.

IntegraCare operates 19 Medicare- and Medicaid-certified home health agencies in Texas, largely in rural areas, and also offers hospice services in some locations. "The founding owners are all retaining equity in the new entity and continuing on in management roles with the company," the release notes.

"This transaction is yet another example of private equity's continued interest in the home health arena" the M&A firm's Steven Braff says in the release.

• Gentiva Health Services Inc. has purchased the home care operations of Winston-Salem, NC-based North Carolina Baptist Hospital, the Mel-ville, NY-based national chain says in a release. Gentiva also acquired Baptist Hospital's respiratory and home medical equipment businesses. Gentiva paid $3.8 million in cash for all three businesses in the Certificate of Need state, according to the release.