Medicare Compliance & Reimbursement

Plus: HHS no longer provides oversight of HIPAA -- you'll instead look to the Office of Civil Rights for guidance on this rule.

Medicare's fraud enforcers are definitely on the move and aren't showing any mercy to offenders. In its latest sweep, 32 people have been indicted on fraud charges related to so-called "arthritis kits," power wheelchairs, and enteral nutrition products, according to a release from the Federal Bureau of Investigation (FBI). Authorities made arrests in Houston, New York, Boston, and Louisiana as part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Departments of Justice and Health and Human Services.

The defendants provided medically unnecessary items or no items at all, the FBI says. "We will protect the Medicare program and its beneficiaries by stopping those who falsely bill for power wheelchairs, orthotic devices and other supplies that are not needed," HHS Inspector General Daniel Levinson says in the release. "Today's arrests demonstrate the significant impact of the new HEAT strike force on combating fraud and abuse in the Houston area."

Houston is the fourth area to be assigned a strike force, after Miami, Los Angeles, and Detroit, the FBI notes. So far, the strike force campaign has obtained indictments of more than 293 individuals and organizations that have bilked the Medicare program for more than $674 million.

• Home care professionals have another tool at their disposal to help stroke survivors cope with post-stroke depression. The nurse-led behavioral intervention program called "Living Well with Stroke" provides individualized counseling sessions using social interactions and physical activity as a way to elevate mood. Researchers conducted a clinical trial involving more than 100 stroke survivors who exhibited symptoms of post-stroke depression and compared LWWS against usual post-stroke care.

The study included participants from 25 to 88 years old, with more than 70 percent having experienced at least one episode of depression prior to their stroke, while 60 percent were taking an antidepressant medication at entry into the study.

Depression scores in the LWWS group were significantly lower after treatment and at a one-year followup. At two years, depression scores continued to decrease and remission rates continued to increase, according to the study, funded by the National Institute of Nursing Research, a component of the National Institutes of Health.

• Overall health care reform may be one step closer to resolution, but its impact on home care isn't looking any more positive. Before adjourning for August recess, the House Energy & Commerce Committee agreed with the other two House committees with Medicare jurisdiction and approved $57 billion in cuts to home health agencies, notes the National Association for Home Care & Hospice.

The Committee also included a provision that calls for a 0.5 percent cut to the consumer price index-urban (CPIU) rate update for durable medical equipment for 2010 to 2013, adds the American Association for Homecare.

Energy & Commerce is set to consider more amendments to the reform bill when it returns in September. One is an amendment reducing the HHA cuts by more than $20 billion and redirecting them, NAHC reports. HHA spending accounts for 4.5 percent of Medicare outlays but is scheduled for 11.4 percent of the cuts, advocates are telling lawmakers. Another amendment up for consideration is the socalled Ross oxygen amendment (H.R. 3220). Thatlegislation has been a lightning rod for the industry, with larger providers and AAHomecare supporting it and smaller providers and the National Association for Independent Medical Equipment Suppliers opposing it.

Meanwhile, bipartisan reform talks between senior Senate Finance Committee members now aren't expected to produce a bill for markup before the Senate adjourns for its August recess. When senators return in September, Committee Democrats and Senate leadership may abandon the talks and come up with their own partisan proposal instead, insiders suggest.

Both houses of Congress will reconvene after Labor Day on Sept. 8.

• Your patients and their caregivers may find a new Medicare resource useful. Ask Medicare, the e-newsletter for caregivers, is gaining a lot of positive feedback. The Web site helps beneficiaries' caregivers make sense of the ins and outs of the Medicare system and is part of CMS's "My Health. My Medicare" campaign. Through this campaign, CMS says, it can help people with Medicare understand and evaluate their health and prescription drug coverage and motivate them to take advantage of all Medicare has to offer.

The site is online at www.cms.hhs.gov/MyHealthMyMedicare/10_AskMedicare.asp.

• GAO calls for increased HHA claims review. CMS and its contractors slacking, federal watchdog claims. The Government Accountability Office wants Medicare to step up its claims reviews for home health agencies. HHA claims review is woefully inadequate, the GAO said in a follow-up letter to an April hearing by the Senate Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security. The hearing focused on Medicare waste, fraud, and abuse.

"In fiscal year 2007, only 0.5 percent of the more than 8.7 million HHA claims processed were subjected to prepayment review," the GAO told Subcommittee Chair Tom Carper (D-Del.) and Ranking Member John McCain (RAriz.) in the July 20 letter. "Of those claims that were reviewed, over 40 percent were denied in whole or in part." "The extent of errors found would suggest that both prepayment and postpayment medical reviews should be increased to more effectively avoid or recoup overpayments," the GAO concluded.

Lax or Overzealous? The GAO also criticized CMS for not routinely sending verification of services billed by HHAs to the authorizing physicians. The docs could "determine whether the type and frequency of home health visits were consistent with what physicians had authorized," the federal watchdog agency said. The GAO knocked durable medical equipment claims as well. The Medicare claims system doesn't identify DME claims patterns that show an atypical increase in billing, the letter said. And fraudulent providers in both the HHA and DME sectors can enter the Medicare program without much trouble, according to the GAO.

The National Association for Home Care & Hospice is all for "well-directed Medicare and Medicaid program integrity efforts," it said. And it supports stronger credentialing of HHA managers.

But contractors' claims review may be getting overzealous. "NAHC is very concerned regarding recent claim determinations issued by Medicare contractors that are in direct conflict with the facts and the law," the association said. "Any increase in claims review should be preceded by expedited and comprehensive educational efforts by Medicare with its contractors to improve the quality and accuracy of their decisions." The letter is online at www.gao.gov/new.items/d09838r.pdf.