Billing
Issues
One area of focus includes home health
agency billing practices, as a prior OIG report found that a quarter of all
home health agencies had “questionable billing.” In addition, the OIG noted that the Centers
for Medicare & Medicaid Services (“CMS) designated newly-enrolled home
health agencies as “high-risk providers” related to a history of fraud, waste,
and abuse. The OIG also cited a figure
that since 2010, “nearly $1 billion in improper Medicare payments and fraud has
been identified relating to the home health benefit.”
Background
Checks and Health Screening
Another area of concern with respect to home
health agencies, includes whether the agencies are conducting exclusion or
criminal background checks on applicants and employees. From a May 8, 2013 Special Advisory Bulletin
on the effect of exclusion from participation in federal health care programs,
we recommend at a minimum that home health agencies are checking the List of
Excluded Individuals and Entities (LEIE) upon hire, and at least annually
thereafter.
In addition, the OIG noted that Medicaid
home health agencies are also required to screen their workers for such
vaccinations as hepatitis and influenza, and compliance with this requirement
will also be reviewed.
Conditions
of Participation
Finally, the 2014 work plan is going to
address whether billing providers have met the Conditions of Participation for
home health agencies, including that the services are provided at the patient’s
place of residence, and on a physician’s orders as part of a written plan of
care, reviewed by a physician every 60 days.
Further, the care provided must require only intermittent, and not
full-time skilled nursing care.
Temporary
Moratoria
The fiscal year 2014 work plan is reflective
of CMS’ recent efforts with respect to alleged fraud by home health
agencies. In July 2013, CMS issued
temporary moratoria on the enrollment of home health agencies in two major
metropolitan areas: the Chicagoland
area, and the Miami, Florida area. On
January 30, 2014, CMS announced that in addition to these two geographical
areas, it has also extended the moratoria to four other metropolitan
areas: Fort Lauderdale, Florida,
Detroit, Michigan, Dallas, Texas, and Houston, Texas. The moratoria are in effect for a six-month
period, which may be extended by CMS by issuing another notice in the Federal Register.
The OIG and CMS’s concerns regarding fraud
and abuse are reminders to home health agencies to revisit their compliance
efforts, and ensure that the agencies are meeting all requirements under both
federal and state laws.
If you have any questions regarding either
the OIG work plan, general compliance with federal and state regulations, or
the temporary moratoria, please contact either Charles MacKelvie (cmackelvie@kdlegal.com) or Jaya White
(jwhite@kdlegal.com).