Medicare Compliance & Reimbursement

3 abandonment criteria can land HHAs in hot water.

The HHS Office of Inspector General (OIG) has specifically stated that abandonment of patients may amount to fraud. At the same time, the list of reasons home health agencies might have for terminating a relationship with a client is growing, cautions Elizabeth Hogue, a healthcare attorney based in Burtonsville, MD. She notes these top concerns:

• Reductions in reimbursement from many payors mean that providers have fewer resources to provide uncompensated care.

• Providers are increasingly aware of the possibility of professional liability when they continue to care for patients who are chronically noncompliant.

• Providers are also more aware of the possibility of violence against staff members.

To prove abandonment, patients and their families--and the OIG--must show the home health providers are guilty of all of the following, explains Hogue. Specifically, a court may charge abandonment when an HHA: 1) unilaterally terminated the provider/patient relationship, 2) without reasonable notice, or 3) when further attention was needed.

Providers Initiate With Caution

If a patient takes the initiative in terminating a relationship with an HHA, the agency is protected from any subsequent charge of abandonment, clarifies Hogue. But because that's not always the case, providers must support any termination they initiate with a solid reason.

For instance, suppose an HHA intends to terminate the relationship because it lacks resources to meet patients' needs. In this case, the HHA's actions could amount to "patient dumping" from the OIG's perspective.

If financial reasons keep an HHA from admitting patients, the agency should be careful not to indicate that it is discontinuing services because of changes in Medicare reimbursement or other payment-related concerns.

"Rather, carefully explain that providers are not allowed to admit or continue services to patients if they lack the resources to meet their needs," says Hogue.

Staff may also explain the inability to provide services based on staffing shortages, if true. Staff must also emphasize that these are the sole reasons for the inability to continue services.