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Home Health & Hospice Week

Industry Notes:

HHS Snatches Back Compensation

Published on Mon May 23, 2005

Regular payroll checks not so good for liquidating prior year's costs.

A Louisiana home health agency is out about $14,000 in compensation reimbursement, plus the cost and headache of an appeal.

The Department of Health and Human Services Administrator overturned a Jan. 7 Provider Reimbursement Review Board decision favoring Metairie, LA-based Family Home Care Inc. (see Eli's HCW, Vol. XIV, No. 5).

The PRRB had said liquidating 1998 compensation to Family Home Care's owners through regular payroll checks issued at the beginning of 1999 was fine. But HHS recently reversed the PRRB's ruling.

"We are really disappointed," Elaine Bergeron, director and co-owner of the HHA, tells Eli.

Family Home Care failed to meet its burden of proof that it was paying for costs accrued in 1998 versus 1999 with the 1999 payroll checks, HHS says.

The HHA has no plans to appeal the decision in federal court, Bergeron says. "This is enough already." 

  • Congress is going to hear all about whether your minutes of care furnished and your reported costs match your payments under the prospective payment system. The Medicare Payment Advisory Commission plans to research those topics as part of its study of home health PPS, according to its June report to Congress.

    The influential advisory body also plans to look at post-hospital versus non-post-hospital patients and patients with characteristics such as marked frailty, caregivers and cognitive problems.
     
  • If you're confused about reading your remittance advices, check out the Centers for Medicare & Medicaid Services' new RA guide. "This Guide is to educate providers about the components of the RA, including the Claim Adjustment Reason Codes and Remittance Advice Remark Codes," CMS says. The 173-page guide is at www.cms.hhs.gov/medlearn/RA_Guide_05-27-05.pdf.
     
  • Priority Healthcare is expanding its infusion portfolio. The Lake Mary, FL-based company has announced it will buy Louisville, KY-based Spectra-Care's $32 million infusion business as well as its medical management component. The deal does not include SpectraCare's home health operation.

    The SpectraCare operation will be integrated into Priority's existing Integrity Healthcare Services specialty infusion business, which has 29 branches in 18 states, reports Priority President and CEO Steve Cosler.
     
  • Dynamic Medical Systems is living up to its name. The Los Angeles-based respiratory, rehab and wound-care provider has completed a $3 million expansion by opening nine branches during the past six months. That represents a growth rate of almost 50 percent for the company.
     
    Dynamic's new branches are in Arizona, Colorado, Idaho, Montana, Nevada, Oregon, Utah, Washington and Wyoming.
     
  • Gentiva Health Care Services is expanding its relationship with managed care plan CIGNA Healthcare. Gentiva's CareCentrix unit will become the "exclusive provider of homecare and related services to CIGNA HealthCare HMO members" in five New England states, the Melville, NY-based company says.
     
  • Brooklyn-based Special Touch Home Care has agreed to a seven-figure payment to settle allegations that it underpaid its aides for overtime, according to New York Attorney General Eliot Spitzer.

    An upcoming audit will determine the exact amount of the settlement, which the AG expects to be around $3 million. Special Touch's attorney puts the figure at closer to $1 million, according to the New York Daily News. The agency believed it was paying aides properly, it says.

    "While we recognize home health care agencies face some difficulty interpreting the complicated federal and state wage and hour laws applicable in this industry, home health care aides must be provided the overtime premium that is afforded to them under state law," Spitzer says in a release.
     
  • A Louisiana HHA exec will spend about two years in prison after pleading guilty to health care fraud last summer. In addition to the jail time, a federal judge sentenced Howard Douglas Austin to $2 million in restitution, a $50,000 fine and three years of supervised release, according to The (Baton Rouge) Advocate.

    Austin and his wife, Annette, founded Health Care Options with offices in Baton Rouge and Lafay-ette. But as part of Howard Austin's guilty plea, charges against his wife were dropped, the paper says.

    A federal grand jury indicted the couple in November 2003 when prosecutors accused them of diverting $2 million from an employee pension plan and billing Medicare for personal purchases from 1996 to 2000. The personal purchases included lawn care, pool services and resort travel, the Advocate says.

    During the sentencing, federal judge Frank Polozola voiced suspicions that the Austins parked their assets in Health Care Options with its new owner, who is a close family friend, to avoid paying restitution. Annette Austin already has repurchased her shares in the agency, the paper reports.

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