Court must approve funds for operations. CMS and the OIG aren't the only federal agencies cracking down on home care fraud. The Federal Bureau of Investigation searched the office of Home Care Hospice Inc. in Philadelphia, reports the Philadelphia Daily News. At the same time, an Oct. 6 temporary restraining order signed by U.S. District Judge Legrome Davis forbids HCH and four defendants from conspiring to defraud the Medicare program. The defendants are HCH President Alex Pugman, Pugman's wife Svetlana Ganetsky, Mat-vei Kolodech, and Kolodech's wife Malvina Yako-bashvili, the Daily News says. The restraining order instructs the defendants not to falsify patient records, backdate service records or revocation requests, submit bills for service not provided, or bill Medicare for a reimbursement rate higher than allowed under federal law. The home health agency and hospice can still operate. But the agency must submit requests to the court for funds to support operations. The defendants have $8.5 million in 39 bank accounts that they may not move, the newspaper adds. • If you're getting claims returned due to reason code 31147, regional home health intermediary Cahaba GBA is offering you a helping hand. Remember: Claims will bounce back "if the fifth position of the HIPPS code billed contains the letters S, T, U, V, W, or X and supply revenue codes 027X or 0623 are not present on the claim," Cahaba explains about the nonroutine supply edit that began on Oct. 1 (see Eli's HCW, Vol. XVII, No. 34, p. 266). You must report the NRS -- including revenue codes, units, charges and a date of service that falls within the "FROM" and "TO" date of the home health claim -- on the claim for it to go through. Or if you didn't furnish NRS, change the fifth digit to a number 1-6 depending on the NRS level. More information and instructions are at
www.cahabagba.com/rhhi/claims/home_health/supplies_nr.htm and
http://www.cahabagba.com/rhhi/claims/home_health/supplies_changes.htm. • The Centers for Medicare & Medicaid Services continues to move forward with competitive bidding for durable medical equipment. CMS is calling for nominations for the Program Advisory and Oversight Committee on DME bidding. "Medicare is committed to making sure that beneficiaries and taxpayers get the highest value for their health care dollars, and evidence from pilot projects has proven that competitive bidding for certain types of DMEPOS items and services can be a major tool in achieving that goal," CMS Acting Administrator Kerry Weems says in a release. "We look forward to working with the new PAOC members to bring people with Medicare higher quality durable medical equipment items and services at lower prices." CMS is ending the current PAOC members' terms because the Medicare Improvements for Pa-tients and Providers Act delayed [...]
