Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 , et al Back when I was a child, I remember reading a story in the paper about how 2% of the welfare recipients were fraudulent and the other 98% were truly in need. The story surmised that the welfare regulations were written for the 2% (in an attempt to prevent fraud). The result was that the other 98% had to live by the regulations crafted to prevent fraud. In fact the report said that regulations were getting to a point where even the experts weren't even sure they understood them. My own profession has endured Enron, WorldCom and many other financial disasters before and after those two. The list could go on and on and the affected professions regardless of the incidents are numerous. So Jim, big deal..., get to the point! The point is, regulation is rampant. There is not one set of rules for everyone. The rules are laid out state by state. Enforcement is difficult as you cross state lines, because who knows what the laws are and which enforcement agency is responsible for seeing things brought to a legal end? While I don't have an answer as to how you can avoid/resolve/enforce, etc., I do think if everyone could move toward one legislative document with a common set of insurance laws we could have a pretty good starting point. In addition, if we did a better job of policing our own. For example, if a new provider opens up in our community, do we know about it? If so, do we know whether they are qualified to care for patients or not? I believe if we all were to take some time to figure out our own market AND regulatory agencies like CMS, State Medicaid and the Blues were to send out lists of providers and locations, we might be able to assist in discovering these problems and shutting them down. In the PTManager blog, I have noted WSJ (Wall Street Journal) reporters have utilized CMS data (through the Freedom of Information Act) to identify providers that have treatment patterns that OFFEND the sensability of anyone that treats. For example, if a normal therapist treats 1 hour per day, 3x per week for 4 weeks on average, the WSJ reporter was able to identify therapists that treated 4 hours per day, 5x per week, 52 weeks a year (and these were not TBI patients). If we talked about it here and could come up with some ideas, I think we could all work toward a better tomorrow. Heck, maybe Towne would be willing to do some part time work (in his retirement) organizing a fraud patrol for all of us (unless his condo association has drafted him to head up the blue hair society...,). Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/892-0142 x 110 visit our website at: www.rehabmgmt.com Re: New on PTManager Blog Well, I hope all those that have repeatedly claimed that fraud is not rampant or a huge problem and those that repeatedly call for less regulations wihtout understanding WHY there are so many Medicare regulations in the first place are reading this and changing there tune. How many more of these studies do we have to have before you understand how bad healthcare fraud is and the extent of the regulatory burden that is placed on us because of it? M Howell,. PT, MPT IPTA Payment Specialist Meridian, Idaho thowell@...> [image: Posterous Spaces] > [image: Your Daily Update] December 6th, 2011 Home health care > firms breaking rules, raking in Medicare dollars - Houston > Chronicle<http://ptmanagerblog.com/home-health-care-firms-breaking-rules-raking> > > Posted about 23 hours ago by [image: _portrait_thumb] > Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=84090448> > > Home health care firms breaking rules, raking in Medicare dollars > TERRI LANGFOR, HOUSTON CHRONICLE Copyright 2011 HOUSTON CHRONICLE. All > rights reserved. This material may not be published, broadcast, > rewritten or > redistributed.<http://www.chron.com/news/houston-texas/article/Home-health-care-\ firms-breaking-rules-raking-in-2342534.php#license-4edcc84543af4> > By TERRI LANGFORD, HOUSTON CHRONICLE Updated 10:11 p.m., Saturday, > December 3, 2011 > > $1.25 billion: Medicare money paid to Houston area agencies over four > years. > > $334 million: Amount paid in 2010. > > 468: Number of companies in Houston region. > > 129: Number of companies paid at least $1 million in 2010. > > 289: Number of companies receiving at least $1 million between 2007 and > 2010. > > Source: Chronicle analysis of Centers for Medicare and Medicaid Services > data > American taxpayers spend tens of millions of dollars on Medicare > (Page 1 of 2) > > The nation's > Medicare<http://www.chron.com/?controllerName=search & action=search & channel=news%\ 2Fhouston-texas & search=1 & inlineLink=1 & query=%22Medicare%22>program > has dished out $1.25 billion for home-based health care in Houston over > four years - and yet nearly every agency that provides nurses, > therapists and drugs for the elderly and disabled has violated state and > federal standards, a Houston > Chronicle<http://www.chron.com/?controllerName=search & action=search & channel=news\ %2Fhouston-texas & search=1 & inlineLink=1 & query=%22Houston+Chronicle%22>investigati\ on > has found. > > Still, little stops the flow of taxpayer dollars to the nearly 470 > companies based in America's fourth largest city. > > Dubbed " deficiencies " by the Texas > Department<http://www.chron.com/?controllerName=search & action=search & channel=new\ s%2Fhouston-texas & search=1 & inlineLink=1 & query=%22Texas+Department%22>of > Aging > and Disability > Services<http://www.chron.com/?controllerName=search & action=search & channel=news%\ 2Fhouston-texas & search=1 & inlineLink=1 & query=%22Aging+and+Disability+Services%22>\ , > they include violations like failure to make sure drugs and treatments > are administered properly and failure to report abuse of a patient. > > Federal authorities say not only are companies falling short on certain > standards of care, some also are bastions for potential fraud - its > victims patients and taxpayers. > > Though federal authorities declined to provide details, citing ongoing > investigations, Assistant U.S. Attorney Justo > Mendez<http://www.chron.com/?controllerName=search & action=search & channel=news%2F\ houston-texas & search=1 & inlineLink=1 & query=%22Justo+Mendez%22>told > the Chronicle that some of the company billings in Houston are the > result of " fraudsters " who " bill for services not rendered. " > > Earlier this year, Houston's Craig > O'Connor<http://www.chron.com/?controllerName=search & action=search & channel=news%\ 2Fhouston-texas & search=1 & inlineLink=1 & query=%22Craig+O%27Connor%22>was > witness to the wiles of the industry. > > His elderly mother, suffering from a poorly healed wound on her foot, > was sent home from the hospital with a recommendation to use a home > health care agency to help her recovery. Instead, he says his mother's > convalescence was turned upside down as workers from the recommended > company made a beeline to his mother's door. > > " This was my first experience with Medicare, and I quickly became > alarmed about all the doctors and health aides who were practically > falling all over themselves to schedule house calls to see my mother, " > O'Connor recalled. > > One of the " doctors " who showed up wasn't even really a doctor, he said. > > Federal auditors repeatedly have noted the exploding and profitable > growth of home health care in the Lone Star State, where Medicare > spending has blown up to three times the national growth rate. > > The Chronicle's examination of payment records showed that even in the > tiny town of Edinburg in South Texas, 27 home health care agencies have > received $331 million over the last four years. > > Two months ago, a Chronicle investigation of the private ambulance > business found millions in Medicare dollars spent on questionable > transports of able-bodied patients to mental health clinics. > > *Booming business* > > Houston's County leads the nation in the number of nonemergency > ambulances, companies and Medicare billings with more than $62 million > coming to some 400 companies in 2009 alone. > > And yet, the home health care industry is even larger - and richer: $384 > million was paid to 468 Houston companies in 2010. > > Like private ambulances, no one state agency is charged with determining > how much money is too much, or how many companies are too many. And > Medicare's direct contact with the companies that bill the mammoth > insurance agency for the elderly and disabled is minimal. > > The Centers for Medicare and Medicaid Services, or CMS, delegates nearly > all of its authority to contractors, a mix of private companies and > state agencies. Those contractors, not the federal agency, decide what > companies qualify for Medicare and pay the patients' bills. > > *'Termination track'* > > In Texas, it's the state Department of Aging and > Disability<http://www.chron.com/?controllerName=search & action=search & channel=new\ s%2Fhouston-texas & search=1 & inlineLink=1 & query=%22Department+of+Aging+and+Disabil\ ity%22>Services, > or DADS, that does the licensing, inspecting and investigating of > home health agencies - a chore it is contracted to do for Medicare as > well. > > If the agency finds federal violations that endanger a patient's health, > the report is sent to CMS and a " termination track " clock begins. The > company has 90 days to correct the problems, with DADS in charge of > checking back. > > Through all of this, however, no one from the $760-billion CMS ever sets > an eyeball on a home health agency in Houston, where 289 companies have > collected $1 million or more from 2007 through 2010. > > Last year, 129 companies hit the $1 million Medicare mark. > > When asked exactly how many agencies in Texas with federal violations > end up on Medicare's " termination " track, CMS' Dallas spokesman Bob > Moos<http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho\ uston-texas & search=1 & inlineLink=1 & query=%22Bob+Moos%22>referred > the question back to Texas authorities. > > " We're not aware of any Texas home health care providers on a Â… > termination track at the moment, but, frankly, DADS will have a better > handle on this, since it's the one that actually does the inspections, " > Moos said. > > Home health care agencies say they're being overly scrutinized because > of fraud in the industry, with nearly every agency getting dinged for > infractions that aren't that serious. > > " I respect the home health industry's position on this, but we're not > going to let up on them, " said DADS Commissioner Chris > Traylor<http://www.chron.com/?controllerName=search & action=search & channel=news%2\ Fhouston-texas & search=1 & inlineLink=1 & query=%22Chris+Traylor%22>. > " Our job is to hold them accountable for any violations we find, and > that won't be changing. " > > The hundreds of deficiencies run the gamut from the bureaucratic, like > missing paperwork, to the problematic: not reporting within 24 hours > knowledge of an act of abuse, neglect or exploitation by a worker; > failing to make sure a patient's care plan is reviewed by doctors; > nurses or therapy supervisors not making home visits when required; not > checking properly for Medicare eligibility; and lacking written plans to > control infection and disease. > > But if no agency is about to be terminated and risk losing tens of > thousands, if not millions of dollars in Medicare money, why have an > inspection system? > > " Our top priority is the health and safety of the clients, " said DADS > spokeswoman Cecilia > Fedorov<http://www.chron.com/?controllerName=search & action=search & channel=news%2\ Fhouston-texas & search=1 & inlineLink=1 & query=%22Cecilia+Fedorov%22>. > " Our investigations focus on the quality of care provided and when we > find that an agency is not in compliance with regulations, we require > timely and appropriate corrections. " > > Last month, the U.S. Department of Health and Human Services' Office of > Inspector > General<http://www.chron.com/?controllerName=search & action=search & channel=news%2\ Fhouston-texas & search=1 & inlineLink=1 & query=%22Office+of+Inspector+General%22>rep\ orted > that contractors charged with detecting fraud have had a series of > problems that " affected their ability to identify potential fraud and > abuse " and track the collection of overpayments. > > *Bad coordination?* > > " The government has enough information that they should be able to find > this stuff. They ought to go look, " said > Hammon<http://www.chron.com/?controllerName=search & action=search & channel=news%2F\ houston-texas & search=1 & inlineLink=1 & query=%22+Hammon%22>, > director of clinical practice and regulatory affairs for the Texas > Association of Home Care & Hospice. " I think the big problem I see is > how the various government agencies coordinate. Each one says 'That's > not what I do' or 'I'm not funded.' " > > Some health care agencies counter that they're made scapegoats by the > inspections as both state and federal agencies are pressured to do > something about the nation's soaring Medicare bills. > > *'I go by the rules'* > > Edna Lewin, administrator of The Trend Health Care > Services<http://www.chron.com/?controllerName=search & action=search & channel=news%\ 2Fhouston-texas & search=1 & inlineLink=1 & query=%22The+Trend+Health+Care+Services%22\ >, > says violations do not mean home health agencies or their workers are > not safe. > > The 32 " deficiencies " her company received in 2009 - the most by one > company in Houston - were all corrected. > > " You need to know the story, " she said. " I live above-board. If I > didn't, I wouldn't be in business. " > > Dorothy , a registered nurse who created her Lanoitan Home Health > Care of Texas in 1978, was cited for 21 deficiencies last year, all of > which she says were corrected immediately. > > " If you look at my record, it's superb, " she said. " I think I'm getting > the flak because there's so much fraud in home health care. I refuse to > be a part of it. I'm old school. I go by the rules. " > > In 2009, the General Accountability Office reported Medicare's spending > on home health care totaled $12.9 billion in 2006, up 44 percent in > 2002. > > It also zeroed in on several problems, some in Houston, including home > health care agencies' propensity to overstate a patients' condition in > order to get Medicare money. Nearly 700 patients deemed most severe > " were served by potentially fraudulent (home health care), " the audit > stated. > > Federal officials in Houston also are investigating kickback schemes and > billing for " services not rendered " but could not comment on specifics. > > " Law enforcement's efforts alone will not stop this fraud, " said Elvis > McBride, who supervises the FBI's Health Care Fraud Task Force in > Houston. " It takes CMS or Medicare to put edits in place to prevent > certain types of payouts. It takes education (for Medicare patients). " > > *Billing doubles* > > Even before Houston's explosive growth in home health care, federal > auditors noted that not only had the number of people getting Medicare > benefits doubled, but so did the number of times agencies billed for a > visit to a patient: from 36 times to 73. > > " I have a problem with the government not watching who is billing what, " > said Anita Bradberry, executive director of the Texas Association of > Home Care & Hospice. " It's not that home health is bad. Home health is > the solution to a lot of our health care problems. " > > via > chron.com<http://www.chron.com/news/houston-texas/article/Home-health-care-firms\ -breaking-rules-raking-in-2342534.php> > > > [image: App] On the go? > *Download Posterous Spaces* for your phone > <http://posterous.com/mobile> > Sent by Posterous. Is this spam? Report it > here<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscriptions>. > Manage or unsubscribe email > subscriptions<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscri\ ptions> > Other > questions? WeÂ’d love to help. <http://help.posterous.com> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 HEAR! HEAR! Dr. Hillyer, PT,DPT,MBA,MSM Hillyer Consulting 700 El Dorado Pkwy W. Cape Coral, FL 33914 Mobile _____ From: PTManager [mailto:PTManager ] On Behalf Of JHall49629@... Sent: Tuesday, December 06, 2011 2:24 PM To: PTManager Subject: Re: New on PTManager Blog , et al Back when I was a child, I remember reading a story in the paper about how 2% of the welfare recipients were fraudulent and the other 98% were truly in need. The story surmised that the welfare regulations were written for the 2% (in an attempt to prevent fraud). The result was that the other 98% had to live by the regulations crafted to prevent fraud. In fact the report said that regulations were getting to a point where even the experts weren't even sure they understood them. My own profession has endured Enron, WorldCom and many other financial disasters before and after those two. The list could go on and on and the affected professions regardless of the incidents are numerous. So Jim, big deal..., get to the point! The point is, regulation is rampant. There is not one set of rules for everyone. The rules are laid out state by state. Enforcement is difficult as you cross state lines, because who knows what the laws are and which enforcement agency is responsible for seeing things brought to a legal end? While I don't have an answer as to how you can avoid/resolve/enforce, etc., I do think if everyone could move toward one legislative document with a common set of insurance laws we could have a pretty good starting point. In addition, if we did a better job of policing our own. For example, if a new provider opens up in our community, do we know about it? If so, do we know whether they are qualified to care for patients or not? I believe if we all were to take some time to figure out our own market AND regulatory agencies like CMS, State Medicaid and the Blues were to send out lists of providers and locations, we might be able to assist in discovering these problems and shutting them down. In the PTManager blog, I have noted WSJ (Wall Street Journal) reporters have utilized CMS data (through the Freedom of Information Act) to identify providers that have treatment patterns that OFFEND the sensability of anyone that treats. For example, if a normal therapist treats 1 hour per day, 3x per week for 4 weeks on average, the WSJ reporter was able to identify therapists that treated 4 hours per day, 5x per week, 52 weeks a year (and these were not TBI patients). If we talked about it here and could come up with some ideas, I think we could all work toward a better tomorrow. Heck, maybe Towne would be willing to do some part time work (in his retirement) organizing a fraud patrol for all of us (unless his condo association has drafted him to head up the blue hair society...,). Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/892-0142 x 110 visit our website at: www.rehabmgmt.com Re: New on PTManager Blog Well, I hope all those that have repeatedly claimed that fraud is not rampant or a huge problem and those that repeatedly call for less regulations wihtout understanding WHY there are so many Medicare regulations in the first place are reading this and changing there tune. How many more of these studies do we have to have before you understand how bad healthcare fraud is and the extent of the regulatory burden that is placed on us because of it? M Howell,. PT, MPT IPTA Payment Specialist Meridian, Idaho thowell@... <mailto:thowell%40fiberpipe.net> > [image: Posterous Spaces] > [image: Your Daily Update] December 6th, 2011 Home health care > firms breaking rules, raking in Medicare dollars - Houston > Chronicle<http://ptmanagerblog.com/home-health-care-firms-breaking-rules-rak ing> > > Posted about 23 hours ago by [image: _portrait_thumb] > Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=84090448> > > Home health care firms breaking rules, raking in Medicare dollars > TERRI LANGFOR, HOUSTON CHRONICLE Copyright 2011 HOUSTON CHRONICLE. All > rights reserved. This material may not be published, broadcast, > rewritten or > redistributed.<http://www.chron.com/news/houston-texas/article/Home-health-c are-firms-breaking-rules-raking-in-2342534.php#license-4edcc84543af4> > By TERRI LANGFORD, HOUSTON CHRONICLE Updated 10:11 p.m., Saturday, > December 3, 2011 > > $1.25 billion: Medicare money paid to Houston area agencies over four > years. > > $334 million: Amount paid in 2010. > > 468: Number of companies in Houston region. > > 129: Number of companies paid at least $1 million in 2010. > > 289: Number of companies receiving at least $1 million between 2007 and > 2010. > > Source: Chronicle analysis of Centers for Medicare and Medicaid Services > data > American taxpayers spend tens of millions of dollars on Medicare > (Page 1 of 2) > > The nation's > Medicare<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Medicare%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22M edicare%22>program > has dished out $1.25 billion for home-based health care in Houston over > four years - and yet nearly every agency that provides nurses, > therapists and drugs for the elderly and disabled has violated state and > federal standards, a Houston > Chronicle<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Houston+Chronicle%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22H ouston+Chronicle%22>investigation > has found. > > Still, little stops the flow of taxpayer dollars to the nearly 470 > companies based in America's fourth largest city. > > Dubbed " deficiencies " by the Texas > Department<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Texas+Department%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22T exas+Department%22>of > Aging > and Disability > Services<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Aging+and+Disability+Services%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22A ging+and+Disability+Services%22>, > they include violations like failure to make sure drugs and treatments > are administered properly and failure to report abuse of a patient. > > Federal authorities say not only are companies falling short on certain > standards of care, some also are bastions for potential fraud - its > victims patients and taxpayers. > > Though federal authorities declined to provide details, citing ongoing > investigations, Assistant U.S. Attorney Justo > Mendez<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Justo+Mendez%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22J usto+Mendez%22>told > the Chronicle that some of the company billings in Houston are the > result of " fraudsters " who " bill for services not rendered. " > > Earlier this year, Houston's Craig > O'Connor<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Craig+O%27Connor%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22C raig+O%27Connor%22>was > witness to the wiles of the industry. > > His elderly mother, suffering from a poorly healed wound on her foot, > was sent home from the hospital with a recommendation to use a home > health care agency to help her recovery. Instead, he says his mother's > convalescence was turned upside down as workers from the recommended > company made a beeline to his mother's door. > > " This was my first experience with Medicare, and I quickly became > alarmed about all the doctors and health aides who were practically > falling all over themselves to schedule house calls to see my mother, " > O'Connor recalled. > > One of the " doctors " who showed up wasn't even really a doctor, he said. > > Federal auditors repeatedly have noted the exploding and profitable > growth of home health care in the Lone Star State, where Medicare > spending has blown up to three times the national growth rate. > > The Chronicle's examination of payment records showed that even in the > tiny town of Edinburg in South Texas, 27 home health care agencies have > received $331 million over the last four years. > > Two months ago, a Chronicle investigation of the private ambulance > business found millions in Medicare dollars spent on questionable > transports of able-bodied patients to mental health clinics. > > *Booming business* > > Houston's County leads the nation in the number of nonemergency > ambulances, companies and Medicare billings with more than $62 million > coming to some 400 companies in 2009 alone. > > And yet, the home health care industry is even larger - and richer: $384 > million was paid to 468 Houston companies in 2010. > > Like private ambulances, no one state agency is charged with determining > how much money is too much, or how many companies are too many. And > Medicare's direct contact with the companies that bill the mammoth > insurance agency for the elderly and disabled is minimal. > > The Centers for Medicare and Medicaid Services, or CMS, delegates nearly > all of its authority to contractors, a mix of private companies and > state agencies. Those contractors, not the federal agency, decide what > companies qualify for Medicare and pay the patients' bills. > > *'Termination track'* > > In Texas, it's the state Department of Aging and > Disability<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Department+of+Aging+and+Disabilit y%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22D epartment+of+Aging+and+Disability%22>Services, > or DADS, that does the licensing, inspecting and investigating of > home health agencies - a chore it is contracted to do for Medicare as > well. > > If the agency finds federal violations that endanger a patient's health, > the report is sent to CMS and a " termination track " clock begins. The > company has 90 days to correct the problems, with DADS in charge of > checking back. > > Through all of this, however, no one from the $760-billion CMS ever sets > an eyeball on a home health agency in Houston, where 289 companies have > collected $1 million or more from 2007 through 2010. > > Last year, 129 companies hit the $1 million Medicare mark. > > When asked exactly how many agencies in Texas with federal violations > end up on Medicare's " termination " track, CMS' Dallas spokesman Bob > Moos<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Bob+Moos%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22B ob+Moos%22>referred > the question back to Texas authorities. > > " We're not aware of any Texas home health care providers on a … > termination track at the moment, but, frankly, DADS will have a better > handle on this, since it's the one that actually does the inspections, " > Moos said. > > Home health care agencies say they're being overly scrutinized because > of fraud in the industry, with nearly every agency getting dinged for > infractions that aren't that serious. > > " I respect the home health industry's position on this, but we're not > going to let up on them, " said DADS Commissioner Chris > Traylor<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Chris+Traylor%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22C hris+Traylor%22>. > " Our job is to hold them accountable for any violations we find, and > that won't be changing. " > > The hundreds of deficiencies run the gamut from the bureaucratic, like > missing paperwork, to the problematic: not reporting within 24 hours > knowledge of an act of abuse, neglect or exploitation by a worker; > failing to make sure a patient's care plan is reviewed by doctors; > nurses or therapy supervisors not making home visits when required; not > checking properly for Medicare eligibility; and lacking written plans to > control infection and disease. > > But if no agency is about to be terminated and risk losing tens of > thousands, if not millions of dollars in Medicare money, why have an > inspection system? > > " Our top priority is the health and safety of the clients, " said DADS > spokeswoman Cecilia > Fedorov<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Cecilia+Fedorov%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22C ecilia+Fedorov%22>. > " Our investigations focus on the quality of care provided and when we > find that an agency is not in compliance with regulations, we require > timely and appropriate corrections. " > > Last month, the U.S. Department of Health and Human Services' Office of > Inspector > General<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22Office+of+Inspector+General%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22O ffice+of+Inspector+General%22>reported > that contractors charged with detecting fraud have had a series of > problems that " affected their ability to identify potential fraud and > abuse " and track the collection of overpayments. > > *Bad coordination?* > > " The government has enough information that they should be able to find > this stuff. They ought to go look, " said > Hammon<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22+Hammon%22> & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22R achel+Hammon%22>, > director of clinical practice and regulatory affairs for the Texas > Association of Home Care & Hospice. " I think the big problem I see is > how the various government agencies coordinate. Each one says 'That's > not what I do' or 'I'm not funded.' " > > Some health care agencies counter that they're made scapegoats by the > inspections as both state and federal agencies are pressured to do > something about the nation's soaring Medicare bills. > > *'I go by the rules'* > > Edna Lewin, administrator of The Trend Health Care > Services<http://www.chron.com/?controllerName=search <http://www.chron.com/?controllerName=search & action=search & channel=news%2Fho uston-texas & search=1 & inlineLink=1 & query=%22The+Trend+Health+Care+Services%22 > & action=search & channel=news%2Fhouston-texas & search=1 & inlineLink=1 & query=%22T he+Trend+Health+Care+Services%22>, > says violations do not mean home health agencies or their workers are > not safe. > > The 32 " deficiencies " her company received in 2009 - the most by one > company in Houston - were all corrected. > > " You need to know the story, " she said. " I live above-board. If I > didn't, I wouldn't be in business. " > > Dorothy , a registered nurse who created her Lanoitan Home Health > Care of Texas in 1978, was cited for 21 deficiencies last year, all of > which she says were corrected immediately. > > " If you look at my record, it's superb, " she said. " I think I'm getting > the flak because there's so much fraud in home health care. I refuse to > be a part of it. I'm old school. I go by the rules. " > > In 2009, the General Accountability Office reported Medicare's spending > on home health care totaled $12.9 billion in 2006, up 44 percent in > 2002. > > It also zeroed in on several problems, some in Houston, including home > health care agencies' propensity to overstate a patients' condition in > order to get Medicare money. Nearly 700 patients deemed most severe > " were served by potentially fraudulent (home health care), " the audit > stated. > > Federal officials in Houston also are investigating kickback schemes and > billing for " services not rendered " but could not comment on specifics. > > " Law enforcement's efforts alone will not stop this fraud, " said Elvis > McBride, who supervises the FBI's Health Care Fraud Task Force in > Houston. " It takes CMS or Medicare to put edits in place to prevent > certain types of payouts. It takes education (for Medicare patients). " > > *Billing doubles* > > Even before Houston's explosive growth in home health care, federal > auditors noted that not only had the number of people getting Medicare > benefits doubled, but so did the number of times agencies billed for a > visit to a patient: from 36 times to 73. > > " I have a problem with the government not watching who is billing what, " > said Anita Bradberry, executive director of the Texas Association of > Home Care & Hospice. " It's not that home health is bad. Home health is > the solution to a lot of our health care problems. " > > via > chron.com<http://www.chron.com/news/houston-texas/article/Home-health-care-f irms-breaking-rules-raking-in-2342534.php> > > > [image: App] On the go? > *Download Posterous Spaces* for your phone > <http://posterous.com/mobile> > Sent by Posterous. Is this spam? Report it > here<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscription s>. > Manage or unsubscribe email > subscriptions<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/sub scriptions> > Other > questions? We’d love to help. <http://help.posterous.com> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2011 Report Share Posted December 10, 2011 [image: Posterous Spaces] [image: Your Daily Update] December 10th, 2011 Should I or Shouldn’t I? (start a business) | TechCrunch<http://ptmanagerblog.com/should-i-or-shouldnt-i-start-a-business-tech\ c> Posted about 17 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=84840072> Should I or Shouldn’t I? (start a business) Altucher <http://techcrunch.com/2011/12/09/should-i-or-shouldnt-i-start-a-business/?utm_s\ ource=feedburner & utm_medium=feed & utm_campaign=Feed%3A+Techcrunch+%28TechCrunch%2\ 9#> posted 2 hours ago 12 Comments<http://techcrunch.com/2011/12/09/should-i-or-shouldnt-i-start-a-busines\ s/?utm_source=feedburner & utm_medium=feed & utm_campaign=Feed%3A+Techcrunch+%28Tech\ Crunch%29#comment-box> View Contributor Page <http://techcrunch.com/author/james-altucher/> I’m on Twitter <http://twitter.com/jaltucher> [image: 466px-Yin_yang.svg] [image: 466px-Yin_yang.svg] *Editor’s note: Altucher <http://en.wikipedia.org/wiki/_Altucher> is an investor, programmer, author, and entrepreneur. He is Managing Director of Formula Capital and has written 6 books on investing. His latest book is I Was Blind But Now I See <http://www.amazon.com/gp/product/B005VPXXVM/>. You can follow him@jaltucher <http://twitter.com/#%21/jaltucher>.* I cried the first day I was an enterpreneur. I left my great job at HBO to full time become CEO of the business I was running on the side. I suddenly went from working 30-40 minutes a day to working 22 hours a day. The first day I was there fulltime, I got the word: the $900,000 I thought the Wu-Tang Clan was going to pay<http://www.jamesaltucher.com/2010/12/the-wu-tang-clan-hitler-and-surviving-y\ our-first-year-of-being-an-entrepreneur/>us to do websites was out the window. Maybe it was never there. Ugh. And then Tupac’s manager laughed me<http://www.jamesaltucher.com/2011/04/how-i-disappointed-tupacs-mom/>out of his office. * I was a failure on day one.* I cried over a slice of pizza. It was salty. When I was leaving HBO my boss there told me, “be careful, once you leave here nobody will return your calls anymore.” And he was right. I suddenly had to enter a world of failure, flexibility beyond anything I had encountered, bribery, psychology, and the depths of human despair that I didn’t know existed. *In other words: the real world.* Here’s what I hated about being an entrepreneur: *human beings.* Most of them suck. Most customers lie to you, for instance. Every customer has the bait-and switch technique: ” if you deliver this to us at this cheap price then, BELIEVE ME, there is a lot more business where that came from.” And that’s before they start asking for bribes. In one form or other, 80% of customers ask for a bribe.<http://www.jamesaltucher.com/2011/10/are-you-a-dirty-entrepreneur/> *Investors are no good either.* “We’re going to add a lot of strategic value.” That’s a euphemism for: when things are going bad we are going to do a down round, ratchet you out of all your shares through dilution, and probably kick you out and bring in a real senior manager. Who will eventually implode the company. Thanks. *Employees are no good either.* For one thing, they sleep with each other. And you have to keep track of it. W is sleeping with X. M is sleeping with Z. It’s like a messed up chart on a white board. Yeah, yeah, there are rules and laws for all this sort of thing. But the bottom line is: if I’m going to keep W from going into an alcoholic frenzy where he disappears for days at a time instead of working on the American Express project then I’m the one who takes the heat. But at the same time, W is happy this second because he’s having sex with X. I mean, who wouldn’t be? *My competition.* I was once running a company where I built websites for other Fortune 100 companies. I had a competitor, Interactive 8. The CEO kept calling me one time but I never returned his call. Two things: I was busy. And I’m horrible at returning calls. It was hard enough for me as a kid calling a girl and asking her out on a date. Now I have to call the CEO of my competitor? Who invented this phone thing anyway. So one time, though, we ran into each other on the street. And he told me a story. It was like a parable and he was jesus. He told me about the CEO of Toys R Us. He called the CEO of Toys R Us and left a message. Within an hour the CEO was calling him back from his private jet. “Good CEOs return calls,” Bill told me. Go F yourself. *Acquirers.* My first company got bought by a company doing a rollup. I stayed a year. By the time I left, the writing was on the wall. Junior high school students were learning how to make websites. You could no longer charge one million dollars to do a website. (PS. This is no joke. One time I called a competitor of mine, Avalanche (later acquired by Razorfish) and, as an experiment in being annoying, I said I wanted a two page website done for my wedding. They said, “uhh, we usually don’t do those”. But I persisted. I said I had to have this website done but I didn’t know how to do something called “H-T-M-L”. They said ok, “but our starting prices are around a million dollars for something like that.” So like I said, the writing was on the wall. And it wasn’t pretty writing. It was like bad graffiti. We’re not talking Banksy here. We’re talking how when I was three years old and wrote curse words all over my neighbor’s windows and then went home after she caught me and called my parents and my dad beat me silly. So I stayed a year and tried to leave. The chairman of the company called me into his office. He said, “When you acquire a company, it’s the closest legal thing to slavery we still have in this country and I can prosecute you to the fullest extent because of that.” Really? Go F yourself also. *Money:* Starting a business requires money. Spending it out of your own checkbook. Getting from your family. Then your friends. Then pitching VCs. Then, on occasion, losing it for everyone, including yourself. That’s so unpleasant. What if you were about to have a kid? What if your friends or family were about to have kids? What if the VC killed himself when he found out. Money is a hard thing to earn, to keep, to love, and easy to spend and lose. I’m sorry to everyone, particularly my kids. *Here’s what I liked about it:* *- Employees: * When I was younger I used to call my parents once every few days and tell them all about whatever job I was in. I’d be proud if my boss said something good to me. I’d feel good about my accomplishments. I wanted all ofmy employees to be able to call their parents at the end of each day and tell them how great their day was, how much they were learning, how much room for advancement there was, how their bosses were thinking of their futures. If you lay out for your employees the future they have in front of them, even if it means they eventually go and start another business, then they will ultimately kill for you. *- Customers:* I loved doing a good job. I liked delivering a project and the client saying, “this is amazing.” *There’s a trick to doing this.* And most startups do not pay attention to this trick although it is critically important. Do everything you said you were going to do. *And then do ONE MORE THING*. Anything. One extra button, one new feature, one thing that surprises. In every business I ever started I would do this. Believe it or not, even for my fund of hedge funds. With every single investor, I’d try to find them a girlfriend, with investors who were having down months I’d call them and try to cheer them up (as long as it wasn’t my fault!). These investors became like family. *- Acquirers.* I loved acquirers. They give you money. I’m still close friends with everyone <http://www.jamesaltucher.com/2011/05/everyone-deserves-a-second-chance/>who has ever bought a company of mine, incuding the guy I mentioned above who talked about slavery. If someone gives me money, I stay loyal forever. I’ve seen many examples of people screw over their acquirers. But loyalty is one of the most important attributes you can have in a short life. And loyalty has many benefits that will occur over and over again. Try it and you will see. But it takes time. *- The network.* When you run a business you ultimately meet many people. I can tell you over the course of being an entrepreneur now for about 17 years that the network increases in value exponentially. And it never goes away. No matter how many times I’ve disappeared. Or not returned phone calls. Or have been lying in the gutter with a needle sticking out of my elbow, the network always returns to pick me up. The key is: never speak badly about anyone. Even the people above who I said “Go F yourself” know that I’m kidding and are still parts of my network. I know too many people who ignore this critical rule: never speak or even think badly about someone else. Eventually, if you do, it will have negative consequences. *- Money*. When you create something that has value, that people use, where the employees are happy coming to work every day, where the clients are singing your praises, where investors are beating your door down and you don’t want to even take their money, where acquirers are calling every day, where business or site usage, or customers are increasing every day. It feels good. And that goodness is compensated. You either make more money from your company or your company gets sold and you make money. It might mean you are a slave for a little bit for the new company. But your kids have a better chance of not being homeless. This is a good thing. Perhaps the most important thing: the myth of corporate job safety is over<http://www.jamesaltucher.com/2011/05/10-more-reasons-you-need-to-quit-your-\ job-right-now/>. You will ALWAYS make more money hustling your own way if you have the ability to bounce back from the non-stop failures along the way. No Fortune 500 company will care for you the way you will care for yourself. One more point: if you are leaving a corporate job to become an EMPLOYEE at a startup you need to do even more due diligence than if you were considering investing cash into a startup. You are investing YOUR LIFE into the startup. So at the very least, check the boxes on the below, quit your job, and then get down on your knees and pray to whatever god you subscribe to: - Talk to clients. Are they happy? - What’s the backgrounds of the heads of sales? - Has the CEO built andsold a business before and taken care of his employees in the process? (this won’t get you into the next Facebook and Google but it will save you a lot of grief overall) - Does the company have at least 1 year’s cash. - What are plans for future rounds of fundraising? - Who are the current investors on board? Do they have deep pockets to keep funding the company? - Is the company squarely positioned in what you feel is a strong demographic trend? - Has the company proven its flexibility (i.e. has it already had a chance to learn from its mistakes) See also, *The 100 Rules for Being a Great Entrepreneur<http://www.jamesaltucher.com/2011/04/the-100-rules-for-being-an-ent\ repreneur/> * There are pros and there are cons to starting a business. The good news is: you learn from all the cons as much as you learn from all the pros. And maybe one of these days* I’ll get it all just right because I’m never going to stop.* via techcrunch.com<http://techcrunch.com/2011/12/09/should-i-or-shouldnt-i-start-a-b\ usiness/?utm_source=feedburner & utm_medium=feed & utm_campaign=Feed%3A+Techcrunch+%\ 28TechCrunch%29> [image: App] On the go? *Download Posterous Spaces* for your phone <http://posterous.com/mobile> Sent by Posterous. Is this spam? Report it here<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscriptions>. Manage or unsubscribe email subscriptions<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscri\ ptions> Other questions? We’d love to help. <http://help.posterous.com> Quote Link to comment Share on other sites More sharing options...
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