Compliance issues frequently occur within the home health industry in referral patterns, billing and coding of claims, contractual and joint venture relationships, and licensure of home health professionals. Listed below are a few fact patterns that should be a cause for concern for the Agency compliance officer.
Q: When should the HHA compliance officer think “Stark”?
A: Anytime the HHA has a compensation/referral relationship with a physician. In a recent case, an Agency paid five physicians for services involving review of patients’ charts and plans of care, participation in regular meetings to review and discuss quality of care issues, and participation in training and staff evaluation. This relationship was held to have violated the Stark Law because it was found the physicians had a prohibited compensation arrangement. In the end, the HHA was held liable for approximately $400,000.
Q: When should the HHA compliance officer think “Anti-kickback!”?
A: Anytime there is a potential for giving anything of value for the referral of patients to someone in a position to refer.
Antikickback Example 1:
A HHA provided free medical alert pages and pager monitoring service to homebound patients during the period that they were receiving home health services. The OIG ruled that, while having potential for fraud and abuse, the arrangement did not violate the law, because the devices promoted and improved quality of care.
Antikickback Example 2:
A nation-wide network of HHAs decided to provide prospective customers with a free “preoperative home safety assessment.” This involved having a licensed physical therapist who either made a house call or telephoned the patient and reviewed with the patient whether the home was suitable for postoperative recovery. The OIG ruled that the assessment was something of value given to the patient which was used to solicit business, and the arrangement therefore violated the Anti-kickback Statute.
Q: When should the HHA compliance officer think “False Claim”?
A: Anytime the facts indicate that a false claim was “knowingly” submitted to the government. In a Department of Justice Press Release on February 9th, 2006, Intrepid USA, a chain of some 150 HHAs, paid an $8 million settlement with the government for submitting false claims to federal healthcare programs “where services had not been provided by a qualified person, where Intrepid had failed to complete and maintain the necessary documentation to support its claims, or where the company had otherwise violated Medicare’s regulations.”
Q: License credentialing. How important is it? When should the HHA compliance officer be on “licensing lookout”?
A: Tenet Hospital in Florida paid a settlement of some $29 million for alleged violations of the False Claims Act, including home health services provided by HHAs based on fraudulent statements or omissions regarding the patient’s medical records, condition, history, or eligibility for medical coverage. Services that were provided by unskilled, unlicensed, or uncertified personnel, or were never ordered by a physician may result in a false claim.
The Parrella Blog thanks Gregory M. Nowakowski
Of Rogers Mantese & Associates, P.C. for his permission to use excerpts of their previously authored article in the HCCA journal.
