Home Health & Hospice Week

Final district court decision yet to come.

A preliminary court decision favorable to a home health agency accused of kickback violations may be too little, too late.

Magistrate Judge James D. Kirk sides with Monroe, LA-based Aging Care Home Health Inc. in an Oct. 30 recommendation to the district judge in the government's case against the home health agency.

Background: In a November 2004 complaint filed in U.S. District Court for the Western District of Louisiana, the government spelled out its charges against the agency, CEO and owner Janice Davis and CFO Otis Davis from 1999 to 2002. Aging Care violated the Anti-Kickback Statute and Stark law by entering into "sham" compensation arrangements with 11 referring physicians, the complaint accused (see Eli's HCW, Vol. XIV, No. 6).

As part of its argument, Aging Care claimed it didn't have to comply with certain Stark provisions because the regulations implementing them weren't final until after the period the lawsuit covers. The government countered that the agency should have complied with the law, regardless of whether final regulations were promulgated.

"The extent of government overreaching in this case is astounding and frightening," Kirk says in the decision. "The evidence at this point in the case shows that [Aging Care and the Davises] may well have complied with the only substantive regulations then in place and thus with the Stark Act."

What's next: Both sides still have a chance to file objections to the magistrate judge's opinion; then the district judge must review it before offering his final decision, notes Liz Pearson, Aging Care's attorney.

"Aging Care was forced out of business by the Medicare program's suspension of payments," fumes Pearson, with Covington, KY-based Pearson & Ber-nard. "We may file action against the government to recoup some of the damage that has been done to them."

"They have lost everything," Pearson tells Eli. "In particular they want their good name back."

• Durable medical equipment suppliers should take note of a new requirement to notify the National Supplier Clearinghouse of any change to the information they provided on the CMS 855S.

New requirement: Suppliers must notify the NSC within 30 days.

The requirement is especially important for suppliers who will be involved in the competitive bidding program, notes Waterloo, IA-based VGM Group on their Web site. These suppliers must ensure the information listed on their supplier files is accurate to enable participation in this program.

CMS recently announced the award of the DMEPOS Competitive Bidding Implementation Con-tract to Palmetto GBA. The program will phase in beginning in 2007.

Information and instruction on how to submit a change of information is on the NSC Web site at www. palmettogba.com/nsc. Once at the site, click on these links: Supplier Enrollment/Change of Information/ Change of Information Guide. Suppliers with questions regarding changes of information should contact the NSC Customer Service Line at (866) 238-9652.

• Regional home health intermediaries are already hard at work processing your M0175 overpayments and underpayments from the first year of the prospective payment system. RHHIs will recoup or refund related adjustments in January, the Centers for Medicare & Medicaid Services has announced (see Eli's HCW, Vol. XV, No. 38).

United Government Services began processing the adjustments related to the OASIS question on patients' prior inpatient stays Oct. 30, it says in a message to providers. "Please note that during the time that the claims are being processed, monies will not be paid or recovered," UGS points out. "Thus, these adjustments will not appear on the Remittance Advice."

Cahaba GBA processed the adjustments Nov. 6, it tells agencies. Most of the adjustments moved to the Return to Provider (RTP) file with reason code 17702. "Home health providers should not correct these adjustments in their RTP file," the intermediary instructs. Cahaba "will take the necessary action to move these claims from the RTP file."

• Nurses' salaries continue to rise. The national median hourly rate for RNs in home health increased 4.5 percent to $25.00 in 2006, according to the HOMECARE Salary & Benefits Report published by Hospital & Healthcare Compensation Service. The national median hourly rate for home health LPNs increased 6.6 percent to $18.50.

Hospital RNs earned $27.37 per hour, while hospital LPNs earned $18.77 per hour, HCS says in the study of more than 1,300 HHAs' compensation data. More information on the study is at www.hhcsinc.com.

• Don't forget to celebrate National Home Care Month, National Hospice Month and Home Care Aide Week in November. Aide week is Nov. 12-18. For ideas on how to mark the occasion, go to the National Association for Home Care & Hospice's Web site at www.nahc.org/hcmonth05/home.html.

• Gentiva Health Services Inc. reported rosy earnings for the quarter ended Oct. 1. Gentiva saw net income of $5.3 million on net revenues of $286.2 million for the quarter, compared to a $4.3 million profit on $219.6 million in revenues for the same period in 2005.

Gentiva cited its acquisition of The Healthfield Group earlier this year (see Eli's HCW, Vol. XV, No. 2) and growth in Medicare revenues for the earnings increase.

• Almost Family Inc.'s profits fell sharply in the latest quarter. The Louisville, KY-based HHA chain reported net income of $1.0 million on revenues of $22.9 million for the quarter ended Sept. 30, compared to a $5.4 million profit on $18.4 million in revenues for the same period last year.

Almost Family CEO William Yarmuth predicts more industry consolidation ahead. "We are seeing an increase in the number of home health agencies being offered for sale," Yarmuth says in a release. That's because "of the difficulties smaller providers have competing with larger regional and national providers in today's complex Medicare environment."

• Amedisys Inc. is entering the Arizona market. The Baton Rouge, LA-based regional chain has acquired Sun Health's home health agency in Sun City, AZ for undisclosed terms, Amedisys says in a release. The agency should contribute about $4.5 million in annual revenues, Amedisys expects.

Amedisys also entered into an agreement with Sun Health affiliate MediSun to furnish home care services to members of its Medicare Advantage plans, the company says.

And Amedisys also disclosed in Securities and Exchange Commission filings that it boosted CEO William Borne's salary to $650,000 plus stock, according to the Associated Press.

The company raised Chief Operating Officer Larry Graham's salary to $425,000.

• Home health aides are among the jobs with the largest projected growth. That's according to a new report from the U.S. Department of Labor. The report, "Occupations with the Largest Projected Job Growth, 2004-2014," was released late last month.

The number of persons employed as home health aides is expected to grow from 62,400 in 2004 to 97,400 in 2014, a 56 percent increase.

• CMS has appropriate controls in place to make sure its Comprehensive Error Rate Testing (CERT) program is coming up with accurate data, the HHS Office of Inspector General cheers in a recent report. CMS has taken steps to reduce the CERT error rate, and followed up on the recommendations in last year's OIG report, the watchdog agency says.

• Medicare won't cover infrared therapy devices for treatment of diabetic and non-diabetic sensory neuropathy, wounds and ulcers, CMS has announced. This includes the treatment of related pain.

Non-covered therapies include monochromatic infrared energy (MIRE), according to decision memo CAG-00291N. For more info, go to www.cms.hhs.gov/coverage and click "What's New."