Home Health & Hospice Week

Once again, a few bad apples are giving the whole home care industry a bad name.

"We fully support any effort to weed out agencies that are abusing the system and trying to profit from it at the expense of patients," notes Andy Carter of the Visiting Nurse Associations of America in a release. "There's no question that a minority of agencies, particularly some new ones springing up in states such as Florida and Texas, are putting profits ahead of care."

The GAO report's "central focus is on the failure of Medicare to do its job to stop these abuses," says Val Halamandaris with the National Association for Home Care & Hospice in its newsletter. "It took nearly two years for Medicare to react to extensive reports of abuse in the Miami-Dade area, reports that came from the home care industry itself."

Senate Finance Committee Ranking Member Charles Grassley (R-IA), who commissioned the report, places significant blame on CMS's shoulders. "There's no excuse for Medicare officials neglecting payment problems," he tells USA Today.

"It seems to me that CMS is just out of touch with the home health benefit and has yet to recognize the vulnerabilities inherent in the system," Grassley criticizes in a March 12 letter to CMS Acting Administrator Charlene Frizzera. "In order to bring much needed integrity into this program, CMS needs to stop dropping the ball."

Bottom line: "Inadequate administration of the Medicare home health benefit leaves the benefit vulnerable to improper payments," the GAO concludes in its report summary.

But it's likely to be the bad actors' fraud and abuse, not the lack of enforcement from regulators, that will capture the public's -- and lawmakers'-- attention, industry veterans fear.

The GAO notes that spending in the states studied doubled that of the rest of the nation from 2002 to 2006. "We know from our own experience that kind of growth usually indicates something is wrong," NAHC's William Dombi told USA Today.But home health spending is still less today than it was 10 years ago.

Nevertheless, an Operation Restore Trust-style crackdown, which put about one-third of the nation's HHAs out of business in the late 1990s, could be on the horizon again, warns consultant Mark Sharp with BKD in Springfield, Mo.

"The stars may be aligning for ORT round two," Sharp and his BKD colleagues warn in an article forthcoming in the American Health Lawyer Association newsletter. Skyrocketing numbers of new providers, high average profit margins, and attention from the GAO are but a few of the factors that contributed to the original ORT and are present today, he warns.

That possibility has industry representatives on the offensive. "What is needed is targeted action against abusers and excessive payments, not an across-the-board, arbitrary rate reduction," Halamandaris insists. "Such action will only result in the demise of the good providers of home health agencies, and the rise of those causing the problem."

"It would be a tragic mistake to let the actions of a minority lead the government to over-react and take any actions to limit appropriate access to high-quality, medically necessary home health care," Carter adds. "Americans need and want to be cared for in their homes whenever possible. We should act to rid the program of the bad actors while at the same time investing in efforts to meet patients' needs."