Medicare Home Health Services

Dear Friends and Colleagues:
Attached you find an article from todays Miami Herald reporting that Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The callous abuse of the Medicare system, a vital lifeline of needed healthcare service for millions of senior patients, has reached new heights in South Florida. here are the facts for Dade county ALONE:

* Miami-Dade is home to 334 Medicare-certified home healthcare providers.
* All together, the top 10 home health providers were paid $139 million by Medicare in 2007.
* Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
* The agency's spending in Miami-Dade totals $1.3 billion out of a nationwide budget of $16.5 billion.
* Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.

There are only two conclusions: either the demand for home health care service has increased by 13 x times the national rate OR (more likely) unscrupulous provides are defrauding the system.

As physicians we MUST work collaboratively with law enforcement and CMS to STOP this abbuse. Every dollar diverted for for fraud will further jeopardize our struggle for reimbursement of physicians services.
We should also NOT stop from reporting those physicians who receive hefty and lucrative referral fees from home health companies. Protecting those "colleagues" means acquiescing to fraud and abuse of the system.

Yours

Bernd



Posted on Sun, Nov. 23, 2008
Ruling halts Medicare payments to more Miami-Dade home healthcare providers
BY JAY WEAVER
Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.

The government agency began the crackdown on the top 10 Miami-Dade home healthcare operators in October, citing potential fraud, but one of the providers sued in federal court claiming Medicare exceeded its authority.

This week, U.S. District Judge Paul Huck sided with Medicare, saying the taxpayer-funded program's suspension policy is ``reasonable and appropriate.''

His decision allows Medicare to continue halting payments to local companies suspected of submitting excessive claims for nurses treating homebound patients who either aren't diabetic or don't need help injecting insulin.

Miami-Dade is home to 334 Medicare-certified home healthcare providers. Many could be affected by the giant entitlement program's unprecedented suspensions.

''Because of the judge's decision, we will be able to expand our efforts to look at other home healthcare companies for payment suspensions and audits,'' Medicare spokesman Peter Ashkenaz said Friday. ``We just want to make sure the people getting home healthcare services are receiving them under the law.''

The judge's decision followed a Miami Herald story that detailed how the home healthcare company that sued Medicare over the suspension policy had billed the agency about $75,000 last year for a nurse to inject the insulin of a homebound diabetic patient.

But the patient, 92-year-old Maria C. Perez, who was living in a Westchester group home, told the Miami Herald that she has never been diabetic and didn't receive twice-a-day insulin injections from a visiting nurse in the latter half of 2007.

Her family doctor and medical records backed up her statement.

Home Care Services Provider, based in Kendall, said it did send a nurse twice daily to treat Perez for diabetes from June to November last year based on a prescribed referral by a Hialeah physician. It denied any wrongdoing.

MULLING AN APPEAL

As for the dispute over Medicare's suspension policy, the company's lawyer said it is considering an appeal of the judge's decision, filed Wednesday.

''We respectfully disagree with the court's ruling,'' attorney Anthony Vitale said in a statement. ``We believed then and we believe now that the Medicare payment suspension regulation is illegal.''

But that dispute with Medicare could be the least of Home Care Services Provider's problems.

The company's Miami-Dade owner, Maria Del Carmen Escarpio, 48, was charged in July with defrauding the Florida Medicaid program, which covers healthcare services for low-income people.

She's accused of using her Kendall home healthcare business to bill the state program $447,000 in wound care supplies and oxygen equipment that were never delivered to Medicaid patients in 2003-04. Moreover, the patients didn't have any wounds or need the oxygen, state authorities said.

''We're vigorously defending her in that case,'' said Escarpio's criminal attorney, Louis Martinez. ``It has nothing to do whatsoever with the current Medicare case [in federal court] nor does it have anything do with the suspension.''

In early October, Medicare suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, citing a spike in questionable billing for diabetic and other services.

All together, the 10 providers were paid $139 million by Medicare in 2007.

The suspensions, which entail audits of claims and payments dating back to 2004, are in effect for at least six months.

FIRST TARGETS

Among the first targets: Home Care Services Provider, which received $12 million in Medicare payments last year.

About 72 percent of its income came from treating mostly homebound diabetic patients, records show.

Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.

The agency's spending in Miami-Dade totals $1.3 billion. Its nationwide budget is $16.5 billion.

Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.

What Medicare officials have found is that the massive health insurance program for the elderly and disabled is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare.

The first round of Medicare suspensions in Miami-Dade were based on ''reliable information'' that home care claims submitted last year ''may have involved an overpayment, fraud or misrepresentation,'' according to an Oct. 3 Medicare letter sent to the targeted companies.

DIFFERENT SIGNATURES

The letter noted that certain physicians had told Medicare that their signatures didn't match those on prescribed patient care plans submitted to home care providers.

But one Miami-Dade operator, Patient Care, Inc., fired back a letter, saying it was ``being unfairly herded into the slaughterhouse as a result of its success and not a single shred of evidence.''