OIG Report Links Miami-Dade Home Health Outlier Payments to Diabetes
Posted on 09. Dec, 2009 by Editor in Breaking News
Medicare officials suspect kickbacks to physicians, beneficiaries.
A new HHS Office of Inspector General report targets home health outlier payments in Miami-Dade County, and legitimate home care providers worry that the crackdown will hurt some of…
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Amy Pastor RN
11. Dec, 2009
They have compared the number of outliers (diabetic patients) to the rest of the states but have not taken into consideration the following:
The elderly STILL come to Miami and retire here
The “snowbirds” stay for months and require these services also.
The majority of the diabetic population are either African-Americans or Hispanics, who are pre-disposed to this disease moreso than others. I agree with cracking down on companies that only want these types of patients in order to collect a large sum of money, or to stop the agencies that have “created” diabetics…patients they are visiting that are not diabetic. This is wrong! I have been in this business for 18 years, specifically in home care. Many of these patients will end up back in the hospital, using up much more medicare money than if they were to be in Home care. I am hearing of Agencies that are currently shutting their doors and patients are not being seen or serviced. That is not appropriate.I am also hearing of many that are the plans are to place these patients in Nursing Homes, that too is very, very expensive. January will be a month in home care history that I will not forget.
Editor
15. Dec, 2009
Thanks for writing in, Amy. One reason these Miami-Dade reports worry me is that in this time of heightened audits and fraud scrutiny, it’s going to be harder for home care providers in some areas to bill Medicare for taking care of their diabetic patients. And for the reasons you mention, some areas may have more *legitimate* outlier payments than others.
That’s why it’s important for home care providers to code correctly and make sure their clinicians document well. We often cover issues like that in *Homecare & Hospice News* (example: see our diabetes coding how-to article from a couple weeks ago here: http://homecarenews.inhealthcare.com/hot-topics/home-health-coding-challenge-double-diabetes-hybrid-diabetes/). And we’ll continue to do so in the future to help HHAs continue to serve their patients as best they can.
Best, Erin Lang Masercola, PhD, CPC