Home Health & Hospice

Weekly roundup

Homecare Insider, June 27, 2016

Supreme Court lets DoL homecare pay rule stand

The U.S. Supreme Court on Monday declined to review a lower court's decision in the case Home Care Association of America v. Weil, effectively ending the legal battle over minimum wage and overtime pay for home healthcare workers. The rule change took effect in October and has been enforced by the Department of Labor (DoL) since January.

The rule had been challenged on the grounds that the DoL lacked the constitutional authority to re-interpret the "companionship exemption" under the Fair Labor Standards Act (FLSA). However, the U.S. Court of Appeals for the District of Columbia Circuit upheld the rule last August. Those opposing the change then petitioned the Supreme Court to review the lower court's decision.

The Supreme Court's decision not to review decision lets stand the DoL's constitutional authority to re-interpret the "companionship exemption" under the FLSA.

Source: Paraprofessional Healthcare Institute

Second pre-claim review forum planned

CMS will host a second special Open Door Forum (ODF) call about the pre-claim review demonstration for home health services. HHAs, physicians, and other interested parties are encouragedto attend. The call is scheduled for 2:00 to 3:00 p.m. Eastern on Tuesday, June 28. For more information and ODF updates, visit the CMS ODF website.

Source: CMS 

CMS revises ICD-10 codes

CMS officially finalized the first major updates to ICD-10 last week, adding almost 2,000 new codes, revising roughly 400, and deleting approximately 300 codes, according to experts who analyzed data posted to the CMS website, Home Health Care News reported.

The agency published the official code changes and impactful revisions in tabular instruction for ICD-10 on its website last week, with more than 3,000 alterations in total. CMS also made many changes to ICD-10 tabular instructions.

The complete addenda list is on the CMS website, as are a revised tabular, alphabetic index, table of drugs and chemicals, neoplasm table, and external causes index. All changes are scheduled to begin when the fiscal year 2017 code set takes effect October 1.

Source: Home Health Care News, CMS 

301 face charges in Medicare ‘fraud takedown’

A nationwide sweep led by the Office of Inspector General (OIG) and the Medicare Fraud Strike Force across 36 jurisdictions earlier this month resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses, and other medical professionals, for alleged participation in healthcare fraud schemes. Twenty-three state Medicaid Fraud Control Units also participated in the arrests, the U.S. Department of Justice (DoJ) announced in a press release last week.

The healthcare “fraud takedown” was the largest-ever, both in terms of the number of defendants charged and the total amount —approximately $900 million in false billings, according to the press release. In one case, nine defendants operating six home health companies in the Miami, Florida, area were charged with submitting false claims to Medicare worth more than $24 million, including claims for “services that were not medically necessary and that were based on bribes and kickbacks,” according to the press release.

Source: DoJ

OIG identifies characteristics of potential fraudsters

In a Data Brief released last week, the OIG said it had identified more than 500 HHAs and 4,500 physicians as outliers on multiple characteristics commonly found in OIG-investigated cases of home health fraud. The finding was based on an assessment of several characteristics commonly found in OIG-investigated cases of home health fraud, according to the brief.

Details of recent fraud cases showed five common characteristics:

  • A high percentage of episodes for which the beneficiary had no recent visits with the supervising physician
  • A high percentage of episodes that were not preceded by a hospital or nursing home stay
  • A High percentage of episodes with a primary diagnosis of diabetes or hypertension
  • A high percentage of beneficiaries with claims from multiple HHAs
  • A high percentage of beneficiaries with multiple home health readmissions in a short period of time

The OIG then identified HHAs and supervising physicians that were statistical outliers for those characteristics when compared to their peers nationally. The OIG also identified 27 "hotspots" in 12 states that were either statistical outliers on the characteristics or contained significant numbers of HHAs or physician outliers. Hotspots were found in Arizona, California, Florida, Illinois, Louisiana, Michigan, Nevada, New York, Oklahoma, Pennsylvania, Texas, and Utah. Seven of these hotspots met multiple criteria, including two—Miami, Florida, and Detroit, Michigan—that met all three criteria, according to the brief.

"Our analysis was not designed to make determinations of actual fraud. Accordingly, the individual HHAs and physicians that we identified were not necessarily engaged in fraudulent activity," the brief stated.

Source: OIG 

Wanted! HHAs that have earned 5 stars on both surveys 

Has your agency earned five stars on both the Quality of Patient Care and the Patient Survey Star Ratings? HCPro would like to know! We hope you’ll share your insights and lessons learned along the way to status as a double-five-star organization. HHAs that want to tell others how they got there and how they stay at the top can contact Mary Stevens, Homecare Insider editor, at mstevens@hcpro.com.