Home Health & Hospice Week

Auditors now have more incentives than ever to identify - and collect - overpayments made to home care providers. In a May 8 memo from the White House Office of Management and Budget, released June 19, OMB Controller Linda Springer says state and local governments can now use a portion of recovered overpayments to pay for recovery contracts.

That means when a state contracts with a firm to identify and collect overpayments in, say, the Medicaid program, the contractor can be allowed a percentage-based piece of the action - just as whistleblowers are under the False Claims Act.

Jack and Margie Mills were convicted in 1996 of Medicare cost report fraud surrounding their home care company, First American Health Care of Georgia Inc., formerly ABC Home Health Services Inc. Many saw the investigation as the catalyst for the home care fraud-and-abuse witch hunt that occurred in the mid to late 1990s.

Jack Mills was sentenced to more than seven years in prison and a $10 million fine for the fraud while his wife was sentenced to more than two-and-a-half years, AP says. The sentences later were reduced.

The investigation of the crash may take six to eight months, AP reports.

Version 1.40 includes a new OASIS item, M0245, as a result of V and E codes being required after Oct. 1 (see Eli's HCW, Vol. XI, No. 28, p. 226).

1) the beneficiary has an open venous stasis ulcer that has been treated by a physician or other healthcare professional requiring medically necessary debridement, and

2) when the gradient stocking can be proven to deliver compression greater than 30 mm Hg. and less than 50 mm Hg.

Suppliers should use the modifier "AW" on claims when those requirements have been met, CMS instructs in the memo.

The State Assembly Health Committee held a June 17 hearing on the controversial legislation, reports the Asbury Park Press. The legislation would set up four Quality Home Care Councils run by New Jersey to employ aides and assign them to patients who receive state-funded home care services.

Proponents of the bill say it would keep private companies from profiting off Medicaid and would reduce aide turnover with higher salaries, but opponents claim it would force aides to work for the government and, eventually, a union, the paper says.

Home health agency M&A actions were up 20 percent to 12 deals, and hospice transactions were down 33 percent to two deals, Braff says in its latest M&A report.

CMS will provide nearly $6 million to demonstration programs that aim to recruit and retain workers who provide personal assistance to people with disabilities.

HHS especially wants to see projects that use health care insurance as an incentive for workers to sign up and stay on, HHS Secretary Tommy Thompson says in a release.

More information is at www.cms.hhs.gov/newfreedom. Applications are due Aug. 12.

The watchdog agency has released half a dozen reports in recent weeks on how well states are doing their job of monitoring drug rebates. While the OIG's recommendations to faltering states primarily focus on internal state procedures, the agency's concern with the issue makes clear its intention to vigilantly watch for federal dollars lost through the program.

According to the OIG's latest reports, Maryland and North Carolina are pretty much on the ball when it comes to accounting for rebates, while Wyoming, Missouri, Arkansas and Kansas still have work to do to get up to speed.

The reports are at http://oig.hhs.gov/oas/oas/cms.html.