Industry Notes:
Home Care Settlement Kept In Check By Self-Disclosure
Published on Thu Feb 19, 2004
SC provider to shell out $9.5 million
When Bon Secours Health System Inc. acquired Greenville, SC-based St. Francis Hospital in 2000, it got a little more than it bargained for - like millions in overbillings to Medicare. Bon Secours set an internal investigation rolling and uncovered system-wide error rates and documentation lapses in the hospital's home health, hospice and durable medical equipment programs from 1997 to 1999, according to an HHS Office of Inspector General release. The mistakes totaled in the millions, and the health system reported its findings promptly to the OIG under the self-disclosure protocol. The $9.5 million settlement is the largest ever reached solely under the OIG's administrative authorities and one of the largest for a self-disclosure, the agency says. Sound bad? It's nothing compared to the hit the hospital would have taken for its home care mistakes had the OIG come knocking first. According to the OIG, St. Francis' quick corrective action and transparency spared it from the mandate of a costly and time-intensive corporate integrity agreement, not to mention millions more in penalties had the OIG sought to recoup damages through the civil monetary penalty law.
If you trip up on certain conditions of participation, it could affect your survey and certification status - but it shouldn't influence your bottom line. That's the message the Centers for Medicare & Medicaid Services gave to its intermediaries after complaints that the contractors weren't paying up if home care providers failed to comply with the Medicare COPs. "This new information will be very beneficial to providers who have questioned if it is permissible to bill for services in cases where they failed to comply with the regulations," says the National Association for Home Care and Hospice. The two most troubling scenarios for HHAs have been whether they can bill when a therapist performs the start-of-care OASIS when nursing is ordered, or when assessments aren't completed in the five-day SOC or recertification window, NAHC says.
Texas is trying to keep more of its residents out of institutions and in their own homes. The U.S. Department of Health and Human Services recently approved a Medicaid waiver to furnish home care and related services to mentally retarded and developmentally disabled residents in the state, it says. The program, which is expected to serve about 4,000 beneficiaries, will pay for respite care, minor home modifications, skilled nursing, adaptive aids, behavioral support, specialized therapies, dental treatment and other services, HHS says. The documentation of the future may be here today. The American Association for Homecare and Schenectady, NY-based Trac Medical Systems have inked a nine-year contract to furnish "an open industry solution" for electronic certificates of medical necessity and other forms, they [...]
