Home Health & Hospice Week

Federal watchdog wants CMS to go further in protecting Medicare enrollment.

Once again, legitimate suppliers are getting a bad rap thanks to fraudsters.

Compliance problems persist with Los Angeles County durable medical equipment suppliers, according to a new report from the HHS Office of Inspector General. The OIG inspected 905 suppliers on four "easily observed rules requiring that each supplier: (1) maintain a physical facility, (2) be accessible during reasonable business hours, (3) have a visible sign, and (4) post hours of operation," the watchdog agency says.

The OIG found that 115 suppliers (13 percent) did not maintain a physical facility or were not open during unannounced site visits. "Another 79 suppliers (9 percent) were open but did not meet at least one of the two additional requirements for the standards we reviewed," the OIG says in a release. Those included posting business hours and business names. An additional 124 suppliers (14 percent) had other irregularities.

CMS is already conducting a fraud-fighting demonstration project focusing on enrollment in the LA area, the OIG acknowledged. But the report offers more suggestions for tightening up the enrollment process, including conducting more unannounced site visits and running more rigorous background checks.

The report is online at http://oig.hhs.gov/oei/reports/oei-09-07-00550.pdf.

• Regional home health intermediary Cahaba GBA is telling providers to put their Medicare legacy numbers back on their claims in some situations. CMS is urging providers to start testing National Provider Identifier-only claims in advance of the May 27 deadline for NPI-only claims.

But providers will see claims returned with reason code 32000 if the claims system can't figure out what kind of claim it is based on the NPI. This happens if a provider has an NPI that applies to subunits that are different provider types, Cahaba explains in a message to providers.

"To correct claims in RTP with reason code 32000, enter your Medicare provider (Oscar/legacy) number in the 'Oscar' field on the FISS Claim Page 01," Cahaba instructs. "To avoid claims from going to RTP with reason code 32000, report the Oscar/ legacy number when you initially submit your claim." Providers may have to acquire an NPI for each subunit to avoid this problem, the intermediary suggests.

NPI information is at www.cms.hhs.gov/NationalProvIdentStand.

• Your local Medicare contractor could soon adopt fraud-fighting practices from other contractors around the country. Infusion therapy fraud in South Florida has encouraged intermediaries and carriers to work together on fraud schemes that spread from one region to another, CMS notes in March 7 Transmittal No. 326 (CR 5725).

In the infusion fraud case, the Florida carrier first developed a series of edits to flag suspicious claims, CMS explains. Then data suggested the fraud was moving to Michigan, New York and New Jersey. Each state's contractors incurred considerable expense to come up with their own edits for the problem.

"As the fraud moves from state to state, the need for a low-cost way to share and implement edits on the fly becomes clear," CMS says.

CMS convened a "Fraud Edit Module workgroup" consisting of representatives from various national and local components to generate "a proactive Fraud Edit Module that allows Medicare Carrier System (MCS) users to implement on--the-fly edits when potentially fraudulent claims are found locally or nationally," the agency says. "The fraud edit module will provide Medicare contractors with an improved fraud editing capability."

CMS' Central Office will collect and distribute the shared edits, the transmittal explains. The missive is online at www.cms.hhs.gov/transmittals/downloads/R326OTN.pdf.

• You have until April 8 to comment on new palliative care standards from the Joint Commission. The standards will be part of a new Health Care Services Certification Program the Oakbrook Terrace, IL accrediting body formerly known as JCAHO will offer.

The draft standards are posted at www.jointcommission.org/Standards/FieldReviews/. "Palliative care services seeking Joint Commission certification will also be expected to use evidence-based national guidelines or expert consensus to guide their services," the organization says in a release.

• More states are considering beefing up their home care funding. One bill in Connecticut calls for creating a one-stop system where families could learn about long-term care services, get help in finding out the best solutions to meet their particular needs, and receive referrals to providers, reports the Associated Press.

A related bill would increase the number of people eligible for a "Money Follows the Person" transfer home from about 700 to 5,000 over five years, AP says. And the bill would fund more training for home care workers.

But state officials oppose the bills, wanting to wait and see how much the limited MFP problem will cost the state first.

Medicaid overhaul: In Tennessee, Gov. Phil Bredesen (D) unveiled his plan for reforming long-term care coverage in the long-troubled TennCare program. The plan aims "to simplify access to home and community-based services and increase the number of people able to stay at home for long-term care needs," Bredesen says in a release.

The restructured benefit would include consumer-directed care, a program for transitioning seniors from nursing facilities to home, and electronic visit verification for home care visits.

• If the Medicare claims appeals process leaves you confused, check out CMS' recently published "Five Levels in the Appeals Process" brochure. The material goes over the following five appeal steps: (1) redetermination by a financial intermediary, carrier or MAC; (2) reconsideration by a qualified independent contractor (QIC); (3) an administrative law judge (ALJ) hearing; (4) review by the Medicare Appeals Council; and (5) judicial review in U.S. District Court.

The document is at www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf.

• Odyssey Healthcare Inc. has completed its acquisition of VistaCare Inc., despite complaints from a major VistaCare stockholder.

Accipiter Capital Management complained the $8.60 per share purchase price wasn't high enough, but Odyssey obtained 94 percent of the stock anyway, the Dallas-based company notes in a release. "Odyssey and its affiliates now own a sufficient number of shares of ... stock to permit Odyssey to effect a 'short-form merger' under Delaware law ... without a required vote of VistaCare's remaining stockholders," the company said after its second offering period March 5.

Odyssey bought the rest of the outstanding shares indirectly and completed its merger March 6, the company says.

• LHC Group Inc. has adopted a poison-pill stockholder rights plan designed to deter a hostile takeover. The plan aims to protect stockholders "against abusive or coercive takeover tactics and takeover tactics not in the best interest of" the company and its investors, the Lafayette, LA-based company says in a release.

Those tactics could include "acquisitions of control without paying all stockholders a fair premium, coercive tender offers and inadequate offers," LHC notes.

"The rights plan is not being adopted in response to any unsolicited takeover proposal," LHC CEO Keith Myers says in the release. The company will present the plan to stockholders for ratification at its next annual meeting.

The company reported worse-than-expected earnings in the latest quarter (see Eli's HCW, Vol. XVII, No. 10). LHC stock rose on the news of the plan adoption, according to MarketWatch.