Home Health & Hospice Week

Use these 4 tips to avoid hot spot pitfalls. Your arrangements with physicians could land you in hot water with the OIG as the watchdog agency increases scrutiny of the relationships. The HHS Office of Inspector General lists "Physician Referrals for Home Health Agency Ser-vices" as one of the five home health agency topics it plans to investigate in 2009, according to the new Work Plan for the year. "We will examine trends in utilization patterns and Medicare reimbursement for services or-dered by referring physicians," the OIG says in the Plan. "We will review Medicare payments for home health claims to identify potential aberrant billing by referring physicians." Whether the OIG intends to look at physicians billing for certifications and care plan oversight or HHAs billing without proper physician signatures is unclear. The Centers for Medicare & Medicaid Services pays a relatively small amount for cert, recert, and CPO by physicians, so it would be surprising for the OIG to scrutinize those payments, says regulatory consultant Rebecca Fried-man Zuber in Chicago. The OIG looking into actual referral relationships for kickback problems would also be a surprise, notes Washington, D.C.-based attorney Elizabeth Hogue. The OIG hasn't delved into this compliance hot spot comprehensively before. Perhaps that's because physicians receive little to no enforcement action based on improper referrals, suggests attorney Marie Berliner with Lambeth & Berliner in Austin, Texas. Tip #1: To steer clear of compliance trouble, "agencies should definitely review their relationships with physicians, especially written agreements for consulting services," Hogue advises. Diabetic Outliers Catch OIG's Eye The OIG appears to be focusing more on home health and hospice in this year's Work Plan, notes Bob Wardwell with the Visiting Nurse As-sociations of America. Between increased OIG scrutiny and the HHA fraud crackdown CMS just announced (see related story, p. 282), "it would be a real good time for the folks who opened HHAs for a fast buck to get on to their next line of business," Wardwell notes. The watchdog agency plans to examine the problem that triggered CMS's fraud crackdown -- outlier visits for diabetic patients. The OIG lists "Medicare Home Health Payments for Insulin In-jections" as one of its investigation areas. "We will examine billing patterns in geographic areas with high rates of home health visits for insulin injections to determine the appropriateness of services billed," the OIG says. "There are reportedly numerous instances of patients not being homebound, not unable to self-inject and, in some instances, not being diabetic at all," Berliner points out. Under the increased scrutiny for outliers that's hitting, "you'd better be right," warns attorney Lucien Bernard with Pearson & Bernard in Cov-ington, Ky. If you serve a geographic area with a high [...]