Home Health & Hospice Week

Fraudulent Texas physician gets the spotlight.

Even though the physician narrative for face-to-face goes away Jan. 1, home health agencies’ reputation for noncompliance may linger.

“We found that for 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements and physicians inconsistently completed the narrative portion of the face-to-face documentation,” the HHS Office of Inspector General says in its latest semiannual report. “This resulted in $2 billion in payments that should not have been made.”

The OIG also noted a high-profile fraud bust in Texas. In a scheme run through Jackson Home Healthcare Inc., Texas Comprehensive Healthcare Resources Inc. and Prestige Health Services Inc. in Houston, a hospital worker accessed hospital files without authorization and obtained patients’ personal health information, which he then sold to Jackson. Employees of TCHR then used the stolen information to contact beneficiaries and solicit them for home care services, including falsely stating that the beneficiaries’ physicians referred them for a home health evaluation when, in fact, the physicians never made a referral, did not establish a plan of care, and were unaware that the beneficiaries were being contacted by a home health agency, the OIG notes.

The involved agencies billed Medicare $12 million for the bogus patients, OIG says. Four defendants in the case were sentenced to a combined 13 years and 7 months in prison and were ordered to pay more than $5.5 million in restitution.

The OIG also highlighted settlements with Amedisys Inc. and Americare Certified Special Services Inc. in New York.

On the hospice side, Harper’s Hospice Care Inc. in Meridian, Miss., agreed to pay $150,000 for allegedly violating the CMP Law provisions on physician self-referrals and kickbacks, the OIG says in the report. Harper’s Hospice paid remuneration to a physician in the form of medical directorship fees. The OIG contends that Harper’s Hospice paid the remuneration to the physician in exchange for the physician referring patients for hospice services and pre-signing blank forms for patients treated by the hospice.

The OIG also reviewed the fraud scheme at Home Care Hospice Inc. in Pittsburgh and the 14-year prison sentence drawn by owner Matthew Kolodesh. Ten other defendants have been sentenced to a combined 8 years in prison in connection with this scheme, the OIG notes.

See the report at http://oig.hhs.gov/reports-and-publications/semiannual/index.asp#sar .