Home Health & Hospice Week

Home care execs are on the hook for alleged fraud.

Home care providers can expect continued fraud and abuse scrutiny in the coming year.

Home health agencies and durable medical equipment providers figured prominently in the HHS Office of Inspector General latest semiannual report to Congress. In the report, the OIG offers a list of HHAs and DME suppliers caught up in OIG enforcement actions this year.

Upcoding: For HHAs, the list includes Colquitt Regional Medical Center's HHA in Sylvester, GA. The agency and its administrators, Coleen Grimsley and James Lowry, allegedly certified and recertified home care patients for medically unnecessary home health episodes, including when patients were not home bound. They also upcoded initial certification diagnoses, the OIG points out. The agency and execs agreed to pay $475,000 to settle the False Claims Act charges.

Impossible visits: The OIG also highlights a case in which a California nurse "who submitted records that purported that she saw 58 patients on a single day, personally made visits that lasted from 30 to 45 minutes each, saw patients every single day during a two-year period, and saw multiple patients in different locations at the same time," the OIG says in the report. LVN Sonia Ogbeni was sentenced to 78 months in prison and ordered to pay $4.2 million in restitution for the fraud scheme.

Fake vaccines: And the fraud watchdog reported the outcomes of two high-profile HHA cases. In 2005 the government filed criminal charges against Iyad Abu El Hawa, owner of Comfort & Caring Home Health in Houston, for his participation in administering bogus flu shots at company-sponsored health fairs as a part of a Medicare fraud scheme (see Eli's Home Care Week, Vol. XIV, No. 40).

El Hawa pled guilty to health care fraud and misbranding of a drug and was sentenced to 46 months in prison and ordered to pay a $15,000 fine, the OIG says. Licensed nurse Martha Gonzales was sentenced to six months' home detention and ordered to pay a $5,000 fine related to the scheme.

"The investigation revealed that over 1,000 fake flu vaccines had been administered to employees of a refinery during a health fair and that senior citizens had been given the fake vaccines at local nursing homes," the report says.

Services not provided: A federal grand jury indicted southwest Virginia-based Homestead Foundational Services owner Rebecca Conyer and bookkeeper Donna Bates on health care fraud, money laundering and mail fraud charges in 2005 (see Eli's HCW, Vol. XIV, No. 31). "Conyer was sentenced to 30 months' incarceration and ordered to pay $923,000 in restitution," the OIG notes. "Bates received a 24-month prison sentence and was held responsible for paying $713,000, a portion of the total restitution amount."

Suppliers' turn: The OIG also lists DME fraudsters, including multiple providers in South Florida snared in two OIG fraud crackdowns--Operation Whack-A-Mole and Operation Equity Excise 2. Several providers were created expressly to bill fraudulently, billing for equipment never prescribed or furnished, the report notes.

The Scooter Store also paid $4 million and relinquished the right to $13 million to settle claims that it furnished and billed for wheelchairs beneficiaries didn't want, need or use. TSS and its owner, Doug Harrison, entered into a five-year corporate integrity agreement with the OIG, the report notes.

The report is at www.oig.hhs.gov/publications/docs/semiannual/2007/SemiannualFinal2007.pdf.

• The Department of Health and Human Services is one step closer to including patient satisfaction in your outcomes rankings. HHS' Agency for Healthcare Research and Quality has requested Office of Management and Budget approval for a home health patient satisfaction survey tool, according to a notice in the Dec. 6 Federal Register.

The Centers for Medicare & Medicaid Services already collects such information for clinicians, group practices, nursing homes and hospitals under the Consumer Assessment of Health Plans Survey (CAHPS) program, the notice says. Now it wants to add HHAs to that list.

"A critical component missing from the current measurement set for home health agencies is information from the consumer perspective on the quality of care provided," HHS says in the notice. "The information collection proposed here will be a field test of a preliminary instrument designed to obtain consumer assessments of home health agency care."

The test: AHRQ plans to pilot the tool in 36 volunteer agencies nationwide, the notice says. The sample of HHAs will vary by size, ownership and organizational type. AHRQ wants to send out about 5,000 surveys and expects to receive about 2,000 responses. Patients will receive the questionnaire and cover letter in the mail and receive an additional followup request for participation by mail and by phone call.

The notice is at www.access.gpo.govsu_docs/fedreg/a071206c.html under AHRQ. To request a copy of the tool, email editor Rebecca Johnson at rebeccaj@ eliresearch.com with "AHRQ Satisfaction Tool" in the subject line.

• DME suppliers now have a date certain for mandatory accreditation. If you are a Medicare-certified supplier with a provider number, you must achieve accredited status no later than Sept. 30, 2009. Fail to and your provider number will be revoked, CMS stressed at a special DME Open Door Forum held Dec. 19.

CMS will announce more details in the transition toward across-the-board accreditation soon, including an accreditation deadline for new suppliers. "Get in the queue now," urged CMS' Sandra Bastenelli at the forum that drew more than 750 callers.

• Hospices can't afford to miss this news: CMS has instructed its contractors to no longer accept physician stamped signatures.

The new instructions came through in Transmittal 220, Change Request 5550 to the regional home health intermediaries on Aug. 24, effective Sept. 3, 2007, but the change is just showing up on most stakeholders' radar screens.

Contractor Palmetto GBA, for instance, did not post provider education on the change until Dec. 7.

"This new language eliminates the ability to use physician stamped signatures and has a special exception for hospices requiring that the "Signature(s) of the physician(s) must be written on the certifications of terminal illness for hospice," notes the National Association for Home Care & Hospice in a recent bulletin to members.

Bottom line: The change eliminates the option of obtaining an electronic signature for the terminal illness certification.

• Take advantage of some free educational opportunities if your regional home health intermediary is Cahaba GBA. During January and February, the intermediary is offering teleconferences and web sessions on appeals, CERT errors, billing for small HHAs and FISS. Find the schedule and registration information online at https://www.cahabagba.com/apps/course_registration/ia/calendar.jsp.

• The government's Christmas present to home care patients and referral sources is adding the two new Home Health Compare measures required by the prospective payment system refinements rule. The Web site now displays "Percentage of patients whose wounds improved or healed after an operation" (79 percent national average) and "Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected" (1 percent national average).

Translation: You know these Outcome-Based Quality Improvement (OBQI) measures as "Improve-ment in status of surgical wounds" and "Emergent care for wound infections, deteriorating wound status."

View your outcomes at www.medicare.gov/HHCompare/Home.asp.

• You'll want to get more familiar with the HIQH query tool for Medicare eligibility as you try to divine accurate M0110 answers under the PPS refinements that take effect Jan. 1.

"HIQH contains more detailed information about Home Health Episodes than HIQA," explains RHHI Palmetto GBA in a Frequently Asked Questions set for this quarter, posted on its Web site.

• Medicare contractors have their marching orders on new deductibles and copays for Medicare beneficiaries. The Part A deductible for 2008 is $1,024, up from $992 this year. But HHA services aren't subject to a deductible or coinsurance.

The Part B deductible is $135 per year, up from $131 in 2007, according to Dec. 14 Transmittal No. 49 (CR 5830). Beneficiaries are subject to 20 percent coinsurance for durable medical equipment.

Hospice may charge 5 percent coinsurance on drugs and biologicals and respite care, CMS explains in the memo. The drug copay mustn't exceed $5 per prescription and is based on the drug copay schedule.

"The amount for respite care may not exceed the inpatient deductible for the year in which the hospital coinsurance period began," CMS adds.