Archive for 'Breaking News'

HEAT On the Lookout for Diabetic Shoe Insert Fraud

Posted on 05. Jan, 2010 by .

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Round up the usual suspects.

New places. The usual suspects — with one quirky new twist.

Last year, the Medicare Fraud Strike Force or ‘HEAT’ busted Medicare fraud rings in Miami, FL; Houston, TX, Detroit, MI and Los Angeles, CA.

This year, HEAT teams will expand to Brooklyn, NY; Tampa, FL and Baton Rouge, LA, according to this release.

Expect HEAT teams to continue to focus on home care and durable medical equipment. The federal fraud scrutiny causes some hardships for legitimate providers and patients — diabetes outliers in Miami, for example. But many providers are glad to see the bad actors get busted and they wonder why the feds take so long to follow up on years-old tips as Medicare funds disappear into some lowlife’s high-living.

As it moves into new frontiers, expect to see HEAT target home care and DME billing fraud involving HIV infusions, arthritis kits, care for diabetes outliers and now, diabetic shoe inserts.

“In Brooklyn, the two defendants are alleged to have billed Medicare for durable medical equipment, including expensive shoe inserts reserved for diabetes patients, when in fact much cheaper and over-the-counter shoe inserts were provided to beneficiaries who often did not need them,” the HEAT release notes.

AUDIO: HEAT and the RACs aren’t the only ones poring over your claims. Learn how to stay compliant — and off the MICs’ radar.

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Clinicians Among 30 Arrested for Home Health Fraud

Posted on 15. Dec, 2009 by .

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Home care benes falsely documented as blind diabetics.

Last week we told you about an OIG report that raised concerns over the high number of outlier payments for diabetic Medicare benes in the Miami-Dade area. Today, federal agents arrested about 30 suspects in three states Tuesday for alleged Medicare fraud totaling $61 million, reports Associated Press.

Once again, diabetes and home care appear prominently in press reports. The fraud schemes involved fake patients and claims for medically unnecessary equipment, physical therapy and HIV infusions, according to AP.

Among those arrested were a Florida doctor and 14 of his staff, including nurses, reports AP. The doctor is alleged to have run a $40 million fraud scheme in which he falsely claimed that patients were blind diabetics so he could bill for home health nurse visits twice a day.

It’s not just the RACs out there auditing you. Are you ready for the MICs? Quick checklist says for sure.

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OIG Report Links Miami-Dade Home Health Outlier Payments to Diabetes

Posted on 09. Dec, 2009 by .

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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 the patients who really need care, reports The Miami Herald.

Among the OIG’s findings:

  • “Miami-Dade County accounted for more home health outlier payments in 2008 than the rest of the Nation combined.”
  • “In Miami-Dade County, Medicare outlier payments for home health claims with a primary diagnosis related to diabetes were eight times the national average.”

Medicare officials, the FBI, and federal prosecutors think that crooked home care providers are paying $100 to physicians for each referral. In addition, the HHAs are paying patients cash to use their Medicare numbers, as well as bribing them with flat screen TVs, groceries and housekeeping, reports the Herald.

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DME Competitive Bidding: Prepare for Grandfathering Headaches

Posted on 01. Dec, 2009 by .

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Physician payment rule spells out requirements for suppliers.

Even if you don’t win a contract under competitive bidding, you can still furnish durable medical equipment or oxygen to your existing clients.

So confirms the 2010 physician fee schedule final rule, published in the Nov. 25 Federal Register. But the decision comes with extra headaches. Suppliers will have to notify in writing both their patients in the bidding area and the Centers for Medicare & Medicaid Services, if they wish to continue furnishing bid items as noncontract suppliers, CMS specifies in the rule. (more…)

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Oregon Hospice Pays $1.8 Million To Settle FCA Case

Posted on 12. Nov, 2009 by .

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The problem? Missing certifications of terminal illness..

A hospice known as ‘Kaiser NW’ has agreed to pay the United States $1,830,322.41 to settle False Claims Act liability, the U.S. Attorney’s Office for the District of Oregon announced November 12. Some of the claims Kaiser submitted to Medicare between 2000 and 2004 lacked the required written certifications of terminal illness.

Kaiser itself disclosed the problem to the HHS Office on Inspector in 2005, according to the Oregon AG’s office. “We encourage disclosures of this nature and we consider them essential to ensuring the protection of the integrity of the Medicare program,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division.

We’ve got your back. The new physician narrative requirement makes it even harder to comply with terminal illness certification. Go to this Homecare & Hospice News post from last week to get a handy form that makes it a little easier.

AUDIO TRAINING EVENT: Hospice GIP and Continuous Care — From Compliance to Reimbursement. With Mary Michal.

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Home Health PPS 2010 Final Rule: 2 Percent Market Basket Update

Posted on 04. Nov, 2009 by .

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Tis the season for red leaves, red tape.

Tis the season for red leaves, red tape.

We’ve got the link that gives you a preview before the rule hits the Federal Register.

It’s that time of year again. The fall leaves are fluttering down from the trees, and pages and pages of final health care reimbursement rules are falling out of Baltimore.

CMS has published it’s final rule updating payments and policies for home health care, according to this agency release.

Check It Out: Go here to get a sneak peek at the rule before it’s published Nov. 10 in the Federal Register. The rule takes effect Jan. 1, 2010.

Highlights about the rule, according to the CMS press release:

Outlier payments for 60-day home health episodes of care: “For CY 2010, CMS will cap home health outlier payments at 10 percent per HHA and target total aggregate outlier payments at 2.5 percent of all HH PPS payments,” the release notes. Currently, in 2009, you have a 5 percent target for total aggregate outlier payments, so the number for 2010 is going to be harder to hit.

2 percent home health market basket update.

The final rule also addresses OASIS-C and Home Health Compare.

Stay tuned to Home Care & Hospice News for a complete analysis of the final rule and what it means to YOUR bottom line.

And, dig deep into what the 2010 final rule does to your HHA’s finances in this audio learning event taught by Aaron Little, CPA.

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Home Health Rehospitalization: Discharged HF Patients Not Getting Recommended Drug

Posted on 27. Oct, 2009 by .

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Only one-third of discharged heart failure patients get this inexpensive, fluid-reducing drug.

If you’re trying to reduce rehospitalization rates among your home health heart failure patients, you may want to check to see if spironolactone or a similarly acting aldosterone antagonist is on their medication lists.

Two-thirds of recently discharged heart failure patients who should be taking such drugs probably aren’t, says a study published in the Journal of the American Medical Association. Researchers looked at 12,565 patients eligible for the widely-recommended drug, all of whom were patients at “201 hospitals that had voluntarily enrolled in the American Heart Association’s Get with the Guidelines program,” reports Associated Press. Apparently, among patients studied, hospitals are ‘getting with the guidelines’ only about a third of the time. (more…)

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News from NAHC: Protect Your HHA Against A Wave Of Denials

Posted on 21. Oct, 2009 by .

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Photo: Thomas Pintaric

Photo: Thomas Pintaric

We’ve got the latest on MACs, RACs & possible new CoPs for HHAs.

Couldn’t make it out to Los Angeles for the National Association for Home Care & Hospice’s annual meeting? Don’t despair. Homecare & Hospice News writer Marian Cannell made the trip west, and she’s got what you need to know from NAHC.

Agencies are seeing increased medical reviews and additional development requests (ADR), said Mary St. Pierre, NAHC’s vice president for regulatory affairs. Denials seem to be targeting homebound status, medical necessity and therapy visits, she told attendees during a NAHC session on regulatory issues. You can expect these to continue as focus on cost cutting increases. Reviewers expect documentation to support every visit, she said.

Strategy: Be sure your clinicians know they must establish realistic goals, have goals with realistic timeframes and clearly document the patient’s condition on each visit. In completing the OASIS assessment, don’t stop with checking boxes for the questions, St. Pierre recommends. Also add a narrative explaining any way the patient differs from the description in the box you check, she emphasized.

In addition, your clinicians need to know that even when you get an episode payment, every visit must show the skilled service provided and why the clinician needs to be there. (more…)

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2010 OIG Work Plan Overview: Home Health & DME

Posted on 07. Oct, 2009 by .

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New to the watchdog agency’s to-do list: outlier payments to HHAs, DSMT & physician self-referral to DME.

Remember that scene in Casablanca when the iffy cop tells a toadie to “round up the usual suspects?” I always think of that line when the HHS Office of Inspector General’s Work Plan comes out.

While there are some new issues in the OIG’s 2010 Work Plan published last week, many should look very familiar. So why review the Work Plan at all?

The document sums up issues that OIG audits and evaluations will review over the coming year, and the OIG’s recommendations make their way to regulators and payer reviewers eyeing your claims. For example, it’s no surprise that some issues mentioned in the Work Plan are also HEAT concerns.

Home Health Roundup —New for 2010

Absent from last year’s work plan, but on the agenda for this year are outlier payments, diabetes self-management training  (DSMT), oversight of OASIS, PPS controls and most interestingly “home health agency profitability.”

The usual suspects: Miscoded HHRGs and insulin payments. The OIG widens last year’s look at Part B therapy for home health benes to the more general “Part B for home health beneficiaries.”

DME Roundup

New for 2010: It’s a perennial compliance issue, but a review of physician self-referral for DME was not in last year’s work plan.

The usual suspects: Power wheelchairs or scooters, hospital beds and accessories, oxygen concentrators, enteral and parenteral nutrition, modifiers, documentation and glucose blood testing equipment.

Want to know more? Our attorney experts weigh in with their Work Plan advice in upcoming Home Care & Hospice News posts.

AUDIO TRAINING EVENT: Medicaid Fraud Enforcement is on the rise — Are you in compliance? With attorney Bob Markette.

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A Few More Good Reasons To Provide Hospice for SNF Residents

Posted on 30. Sep, 2009 by .

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And a surprising finding — non-hospice patients benefit too.

It must be true, because it comes from the Ivy League. Two Harvard researchers have concluded that having a hospice for SNF patients benefits all SNF patients, not just those in hospice, according to an article published this month in the Journal of Pain and Symptom Management.

Not surprising: Hospice is underutilized among SNF patients. “Only six percent of nursing home residents in the U.S. currently elect the hospice benefit, even though nearly one-in-four deaths in the U.S. occur in a nursing home,” according to this press release.

Among the SNF-hospice combo bright spots, the researchers found:

  • SNF hospice  patients have fewer hospitalizations and improved pain management, compared to end-of-life SNF patients who don’t choose hospice.
  • Researchers also discern a positive effect on non-hospice SNF patients when there is a hospice, a trend they link to improved clinical practices across the board at the SNFs.

The Harvard researchers note that the SNF-hospice combo needs to be studied further, with a changing case mix (more dementia patients) and an incomplete understanding of costs being two key issues.

AUDIO TRAINING EVENT: Conquer the new CoP and MedPac challenges, with Mary Michal.

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