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Home Health & Hospice Week

Industry Notes:

WHISTLEBLOWER RACKS UP $6.1 MILLION HOME HEALTH SETTLEMENT

Published on Thu Jul 08, 2004

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 expects to have more than 200,000 customers, it told the newspaper.

  • Akron, OH-based Cambridge Home Health Care opened its twentieth office on July 6 in Sandusky. The company, founded in 1994, has more than 1,000 employees and serves more than 2,000 patients, it says.

  • A Clarksville, TN HHA owner is facing fraud charges over shifting costs from his private duty business to his Medicare business, reports The (Nashville) Tennessean.

    Charles Madison Warren III, owner of Complete Home Health Care and Complete Health Professional Services, faces three counts of health care fraud and five counts of making false statements related to health care, according to an indictment from the Tennessee U.S. Attorney. Warren shifted costs from private duty Complete Health Professional to Medicare-reimbursed Complete Home Health from 1998 to 2000, prosecutors say.

    If convicted of the health care fraud charges, Warren could be sentenced to 10 years in prison and could face a fine of up to $250,000. Making false statements carries a prison term of up to five years and a fine of as much as $250,000.

  • Personal care provider Natailya Skrin-skaya faces up to five years in prison and a $10,000 fine -- as well as a five-year exclusion from federal health care programs -- for allegedly billing for work she never performed.

    According to Maryland Attorney General J. Joseph Curran, Jr., Skrinskaya pled guilty July 2 to one count of Medicaid fraud for allegedly claiming thousands of dollars worth of home care services that she could not have provided because she was on vacation. Arelease said that Skrinskaya also billed Medicaid for work supposedly provided to a beneficiary in his apartment on dates when the person was actually living in a nursing home.

     

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