Home Health & Hospice Week

Quality, therapy, ALFs top OIG hit list  Don't be surprised if federal investigators take a fine-toothed comb to your relationships with assisted living facilities in the coming year. "Home Health Agencies' Arrangements With Other Facilities" is one of the six HHA-specific projects set out in the HHS Office of Inspector General's fiscal year 2004 Work Plan. The plan mentions relationships with health systems, nursing homes and rehab facilities, but it is ALF relationships that will prove the most fertile ground for fraud - and thus of most interest to the OIG, experts say. "ALF connections are a huge issue," stresses Gene Tischer of trade group Associated Home Health Industries of Florida. HHAs run into two major problems with their ALF relationships: 1) Kickbacks. Many HHAs are providing something of value in exchange for ALF referrals, and that's a kickback under federal and many state laws, Tischer notes. "This is felony stuff," he says. ALFs are pressuring agencies to furnish them with services such as chart audits in exchange for their business, reports Burtonsville, MD-based attorney Elizabeth Hogue. 2) Patient choice violations. Often, in exchange for something of value, ALFs agree to establish a so-called "preferred provider" relationship with an HHA, notes attorney John Gilliland II with Indianapolis-based Gilliland & Caudill. But that status often means ALFs simply don't allow other agencies in to see their patients, which is a violation of Medicare patient choice regulations. In addition to those two hot buttons, some HHAs appear to be disregarding the OIG's directions, contained in its model home health compliance guidance, to make sure they aren't duplicating ALF services under state regulations, says Hogue. Tischer welcomes the OIG's probe into the area, noting that agencies "trying to do the right thing are getting killed" by those offering kickbacks to facilities for their business. "This is widespread, and there has been no enforcement," he tells Eli. The OIG also might investigate hospital referrals and patient choice under this area, adds attorney Greg Naclerio with Ruskin Moscou Faltischek in Long Island, NY. "If the vast majority of a hospital's patients go to its HHA," the OIG may look at whether the hospital is truly giving patients a choice of providers as required by the Balanced Budget Act of 1997, Naclerio says. Other project areas addressed in the Work Plan include: Quality. The OIG plans to investigate whether the prospective payment system has affected home care quality, according to the plan. To gauge quality levels, the watchdog agency will look at changes in the level and mix of services offered by HHAs, the number of hospital readmissions and emergency room readmissions, and the number of survey deficiencies. HHAs can take a cue from the nursing [...]