Salinas, CA : Home Health Care Providers Under Fire For Overbilling : View From A Private Duty Caregiver Serving, Carmel, Carmel Valley, Carmel-by-the-Sea, Gilroy, Gonzalez, Greenfield, Hollister, King City, Marina, Monterey, Pacific Grove, Pebble Beach, Salinas, San Juan Bautista, Seaside And Soledad California
Home Health Firms Blasted was the title of a front page story of the Wall Street Journal on Monday, and the article was harshly critical of three firms that provide home-health services, seeking reimbursement from Medicare, Medi-Cal and other insurance (unlike Family inHome Caregiving which is private-pay, non-medical). The article said an inquiry by the Senate Finance Committee found that the nation's three largest home-health companies tailored their care provided to Medicare patients to maximize their reimbursements. The article didn't really surprise me. Home Health care payments have taken it in the chops for many years. I wrote on my blog on Tuesday about a case before the U.S. Supreme Court challenging California's rights to chop payments to hospitals and home health care companies for the third straight year which are processed through the Medi-Cal system. The cost of providing home health keeps going up, while the rate of reimbursement is going down. That's not to say that it's OK to skirt Medicare rules to get higher payments, but government officials need to realize that continuing to cut payments is going to hurt patient care and cause some unscrupulous companies to try and cheat on the billing to make up for lost payments. There needs to be another solution other than continued reductions in payments. The Senate findings came after the Wall Street Journal last year analyzed Medicare-claims data and found that home health companies gave Medicare patients a number of the most profitable type of home-therapy visits but few of the least profitable ones. For instance, one company started switching wound payments from skilled-nursing visits to physical therapy visits because the latter gets reimbursed at a higher rate. The companies being investigated are Amedisys Inc., LHC Group Inc. and Gentiva Health Services Inc., all three of which receive the bulk of their revenue from Medicare payments. The industry's pattern of visits changed a fter 2008 when Medicare started to pay home-health firms bonuses for 6, 14 and 20 therapy visits versus the previous 10. Ironically, the benchmark of 10 was implemented to encourage home health care companies not to be skimpy on care. But that meant that someone who needed 8 visits probably got 10, and someone who needed 12 visits probably got 10. The new change caused many to start visiting patients 14 times or 20 instead of 10. After 2008, the average for 6 visits was up 19%, 14 visits up 42% and 20 visits up 30% while 10 visits were down 43%. This type of bonus system strikes me as bizarre as it focuses on an artificial number rather than the actual visits that a person needs. It appears that these firms tried to game the system, and after pulling emails and other internal documents from the companies it was discovered that they were actively encouraging employees to make visits that would trigger bonus payments, whether the patients needed them or not. They are in a lot of trouble, with not just the potential for civil liabilities but criminal as well. The panel issued a report that said their business practices represented at best abuses of the Medicare program and at worst, "they may be examples of for-profit companies defrauding" the program at taxpayer expense. Thankfully, the report also recommended that Medicare and Medicaid stop using the number of visits as a gauge of how much home health companies are paid, a policy I vehemently disagree with. Health care needs to come as needed, not on a per bucket basis, as each patient's needs are completely different. One of the three companies under attack, LHC Group, has already agreed to a $65 million settlement with the Justice Department last week for improper billing for services which weren't medically necessary between 2006 and 2008. This new investigation leaves them open for charges of overbilling in 2009-2011. It's good to see that the bonus system may change, but it's sad that it ha d to come to this level of billing abuse in order for someone to pay attention./article/SB10001424052970204612504576606791708892886.html/blog/index.html?entry=pacific-grove-ca-u-sAbout Richard Kuehn & Family inHome Caregiving of Monterey:After more than a decade of caregiving, both in a professional environment and for a 97 year old family member I was dissatisfied with service from local caregiving agencies. I became convinced of the need for a service which provides very personal assistance to elderly and founded Family inHome Caregiving serving the Monterey Peninsula. Please visit my blog where I talk about important senior issues at:/Blog
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