Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 [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 This material may not be published, broadcast, rewritten or redistributed.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 … 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? We’d love to help. <http://help.posterous.com> Quote Link to comment Share on other sites More sharing options...
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