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Home Health & Hospice Week

Industry Notes:

Nurse Registries Featured In CA Fraud

Published on Thu Mar 04, 2004

Hardships for all providers a likely upshot, CMS says. 

Nurse registries served as a "vehicle for not performing services" in the recently disclosed $100 million fraud case against three home health agencies in the Los Angeles area.

So says a Centers for Medicare & Medicaid Services official. In the scheme, the three HHAs contracted with nurse registries to staff cases, but the registries didn't furnish visits, even though the agencies billed for the episodes (see Eli's HCW, Vol. XIII, No. 7).

The HHAs and nurse registries were working together to submit the fraudulent claims for patients that never received home care, the CMS top official tells Eli. The registries approached the agencies with the scheme.

"One bad provider can ruin it for all the good providers," the CMS source says as the agency considers procedural changes for HHAs as a result of the fraud discovery. Chances are such changes would involve more administrative burdens.

"Dealing with one bad apple can hurt others," so HHAs should report anything that doesn't appear kosher to the HHS Office of Inspector General or other fraud hotlines, the official urged.

  • The health care spending gap between women and men, affluent and poor, and whites and minorities narrows or disappears in the last year of life for Medicare patients, according to a new study by RAND Corp. Spending gaps in all three categories are evident earlier in life for the more than 240,000 patients studied, RAND says in a release.

  • A Cook County, IL jury returned a $30 million verdict Feb. 24 against home health agency Home First after an infant patient died 16 days after birth, reports the Chicago Tribune.

    The medical malpractice lawsuit alleged Home First's staff failed to test the baby's blood, which was different than the mother's, or recognize signs of jaundice, which led to a condition causing brain damage and death in 1998.

    Home First's attorney says the HHA will appeal the verdict, according to the Tribune. The verdict sets a record for an award related to a death resulting from a birth injury.

  • Mergers and acquisitions for HHAs and home medical equipment suppliers were up in 2003, reports The Braff Group. HHA deals compiled by Braff rose from 34 in 2002 to 41 in 2004, a 23 percent increase. HME deals increased from 69 exchanges in 2002 to 78 in 2003, a 13 percent rise.

  • Roto-Rooter Inc. completed its acquisition of the nation's largest for-profit hospice chain, Miami-based VITAS Healthcare Corp., on Feb. 26. Cincinnati-based Roto-Rooter's Comfort Care Holdings subsidiary merged with VITAS.

    Observers predict a fairly speedy spin-off and possible initial public offering of VITAS, which reported revenues of $420 million for the fiscal year ended Sept. 30, 2003.

  • Amedisys Inc. has finalized its plans to purchase 11 HHAs and two associated hospices from Tenet Healthcare Corp. for $19 million in cash, the Baton Rouge, LA-based regional provider says. Amedisys will take over the agencies, which are in Texas, Louisiana, Mississippi, Tennessee, Alabama, Georgia and Florida, in three stages from March 1 to May 1.

  • For-profit hospice chain VistaCare Inc. is racking up more stellar earnings. The Scottsdale, AZ-based company reported net income of $15.2 million on revenues of $191.7 million for the year ended Dec. 31, compared to a $7.6 million profit on revenues of $132.9 million for 2002.

    The hospice company plans to focus on increasing referrals from hospitals in the coming year, it says.

  • Rotech Healthcare Inc.'s revenues are down but profits are up for the quarter ended Dec. 31. The respiratory and HME company reported net income of $8.1 million on revenues of $140.6 million, compared to a $2.1 million profit on $154.9 million in revenues for the same quarter in 2002.

    Rotech's ratio of respiratory equipment service revenues increased in the quarter while its HME portion dropped.

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