Qui tam case hinged on medical necessity. Phoenix-based Banner Health will pay $6.1 million to settle false claims charges for home care visits delivered in Wyoming. The whopping settlement for Banner, formerly known as Lutheran Health Systems, results from a whistleblower lawsuit filed by former Banner employee Debbie Evans, according to the U.S. Department of Justice. Evans, who worked at Washakie Medical Center in Worland, WY, will rake in a cool $1 million under the False Claims Act, reports the Associated Press. The suit alleged that Lutheran "filed claims that were either not reasonable and necessary or for which the amount, frequency and duration of services were not reasonable and necessary," the DOJ says in a release. The suit addresses home health claims from 1995 to 1999, AP says. The claims were made before Banner was created through the merger of Samaritan Health System and Lutheran. Banner operates Wyoming home care locations in Torrington, Wheatland, Worland and Cheyenne, AP says. Banner denies any intentional fraud. The National Association for Home Care & Hospice is seeking clarification from the Centers forMedicare & Medicaid Services on its drop-off site policy. After an announcement in the June 23 open door forum that drop-off sites or work stations are not permitted (see Eli's HCW, Vol. XIII, No. 23), agencies are confused. "Although there is no federal definition of 'drop sites' or 'workstations,' some states define and regulate them under state law," NAHC notes. "Many state survey agencies are aware of and permit HHAs to maintain drop sites."
NAHC plans to stress in the requested meeting that functions that take place at drop sites also take place in patients'homes and in staffers'cars. Regulators must remember that home care is provided in the community rather than institutions, the trade association says. CMS soon will issue a revised form for on-site inspections of durable medical equipment suppliers, along with new instructions and regulations. The agency has submitted the materials to the Office of Management and Budget for approval, CMS says in the July 16 Federal Register. CMS previously indicated it would be changing Medicare enrollment procedures as part of Operation Wheeler Dealer. The agency will post its revised form CMS-R-263 and related materials at
www.cms.hhs.gov/regulations/pra/. Disease management firm Matria Health-care has sold its specialty pharmacy and supplies business to a subsidiary of Clearwater, FL-based CCS Medical for $102 million in cash, the Marietta, GA-based company says. Matria operated the business through its subsidiaries, Diabetes Self Care Inc. and Diabetes Management Solutions Inc. The newly merged diabetes supply company will go head-to-head with industry heavyweights such as PolyMedica Corp. (Liberty) of Woburn, MA and Salem, VA-based National Diabetic Pharmacies, reports the Roanoke Times & World News. CCS [...]
