Miami - Dade county tops the list again.
Investigators of the Government Accountability Office (GAO) cited that:
> Unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the
average rate in all other major metro areas nationwide.
> The number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than
half of that increase occurred in two states, Florida and Texas.
> In 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits
-- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients
using Medicare home services grew by 17 percent.
> In Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients.
That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta,
even though there are more people over age 65 in each of those metro areas, the report says.
What are the factors contributing to the problem?
> Unscrupulous business people who can open a home-health company without any background screening or proper vetting
procedure.
> Unethical doctors who expect and receive CASH payment in brown bags (yes, its true) for each patient referral, even though
home health care is not indicated.
> Medicare outsourced home health administration to private contractors who are not being watched or being held
accountable for their services.
SOLUTIONS:
> Stop private contracting process(Moratorium)
> Freeze licensure of all home health companies in Dade County and review their business practices. Unfortunately, South
Florida politicians do not have the guts (or cannot afford being cut-off from a guaranteed money flow) to stand up to that
Home Health lobby.
> Revoke the license of each and every doctor who accepts kickbacks.
Radical solutions? Yes they are! But something has to be done to stop the bleeding!
PS: Please send all hate mail and threats to the State Attorneys office.
Posted on Fri, Mar. 13, 2009
Study blasts rampant healthcare fraud, especially in Miami-Dade
BY JAY WEAVER
A U.S. government watchdog agency has singled out Miami-Dade County for acute fraud in the $13 billion home healthcare industry, in a newly released report that spotlights runaway costs due to suspicious Medicare billing.
The Government Accountability Office cited the unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the average rate in all other major metro areas nationwide.
GAO investigators blamed Medicare for poor oversight of home healthcare agencies, citing hundreds of millions of dollars in ''improper payments'' for fraudulent claims in Miami, Houston, Los Angeles and other metropolitan areas.
The findings of the report, which analyzed 2002-2006 Medicare billings, angered the ranking Republican member of the Senate Finance Committee. U.S. Sen. Charles E. Grassley, R-Iowa, warned top officials of the nation's health insurance program for the elderly that they must confront fraud as part of President Barack Obama's goal to reform Medicare.
''I regret to say that it seems to me that [Medicare] is out of touch with the home health benefit and has yet to recognize the vulnerabilities inherent in the system,'' Grassley wrote Medicare's acting administrator.
``In order to bring much needed integrity into this program, [Medicare] needs to stop dropping the ball.''
Several of the troubling findings in the GAO report -- including questionable Medicare billing by Miami-Dade home healthcare agencies for services either not necessary or not provided -- were disclosed in The Miami Herald last November. The story showed that the problem has continued beyond the five years covered in the GAO report, with billings reaching $16.5 billion last year.
Medicare officials said they have taken steps to stop fraud -- including suspending more than $100 million in annual payments to 13 home healthcare agencies in Miami-Dade last fall. They're suspected of overbilling for nurses treating homebound diabetic patients who don't need help injecting their insulin.
Medicare is also conducting audits of claims and payments to determine whether services were actually prescribed by doctors and provided by agencies.
BACKGROUND CHECKS
But Medicare said it isn't screening home healthcare applicants for criminal backgrounds, as recommended by the watchdog agency.
The GAO report found that in 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits -- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients using Medicare home services grew by 17 percent.
Overall, home healthcare spending was highest in California, Florida, Louisiana, Nevada, Oklahoma, Texas and Utah.
Another startling statistic: the number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than half of that increase occurred in two states, Florida and Texas.
'UPCODING' RAMPANT
GAO investigators said that as those numbers have soared, so have fraudulent and abusive billing practices. Among them: ``upcoding -- overstating the severity of a beneficiary's condition.''
That practice is rampant in Miami-Dade, where home healthcare agencies are suspected of paying kickbacks to homebound patients diagnosed with diabetes who don't need nurses to inject their insulin twice daily.
The GAO report noted that in Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients. That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta, even though there are more people over age 65 in each of those metro areas, the report says.
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2009-The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals, but failed to note that Scott resigned from HCA in 1997 amid a federal investigation into the company's Medicare billing, physician recruiting, and home-care practices. HCA eventually pleaded guilty to fraud charges and paid approximately $1.7 billion in fines and penalties.
THURSDAY, JUNE 26, 2003; WWW.USDOJ.GOV;
WASHINGTON, D.C.
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED; HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
Note: Hospital Corporation of America (HCA) was acquired by Columbia in 1994.
Why does this matter? The wrath of Richard Scott and friends is to this day still affecting main street America.
Who is Richard Scott? More importantly, who are Richard Rainwater & his wife, Darla Moore?
Before GW Bush was affiliated with Richard Rainwater may I remind you-Richard Scott was the ex-partner of Richard Rainwater with Columbia Homecare Group.
In 1997, Fortune magazine ran a cover story on successful business executive Darla Moore, titled "The Toughest Babe in Business."….She created the corporate bankruptcy finance tool, DIP, debtor in possession while at a Wall Street bank.
July 26, 1997, Los Angeles Times article:
A controversial deal maker whose hard-nosed business tactics have reshaped the medical industry resigned Friday as scandal engulfed the vast hospital empire he had assembled over the last decade.
Richard Scott -- sometimes called "the Bill Gates of health care" -- quit as chairman of Columbia/HCA Healthcare Corp. amid a massive federal investigation into the Medicare billing, physician recruiting and home-care practices of the nation's largest for-profit health care company.
On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA to negative bases on
poor earnings. Looks like Rainwater and his Crescent Cos' have finally stumbled. One source within the company said it would be a long while before any new high-ticket acquisitions would take place. A previous deal with Prudential is in danger of being jettisoned.
Why does this matter- September 8, 1998?
An FYI relating to the need for ‘healthcare financial service’ i.e. (NCFE) National Century Financial Enterprise in 1998: home health - which was struggling under the Balanced Budget Act of 1997; about 1,400 agencies closed nationwide in 1998.
We must review the case that just ended in December 2008: National Century Financial Enterprises, Inc. (NCFE)
In 2002, FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio. November 2002, NCFE filed bankruptcy in Columbus, Ohio.
“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.
At trial, the government presented evidence that the defendants engaged in a scheme to deceive investors and rating agencies about the financial health of NCFE and how investor monies would be used between May 1998 and May 2001.
FYI- between May 1998 and May 2001, James K Happ, prior to his arrival at NCFE, was the chief financial officer of the Dallas-based Columbia Homecare Group, Inc.
Do you know how many Columbia home health companies and Solueus/IHS Homehealth care companies were in Florida in 1998?
Do you know where they all went?
NCFE!
home health - which was struggling under the Balanced Budget Act of 1997; about 1,400 agencies closed nationwide in 1998.
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