Beware this punishing legal tactic.
A lawsuit to challenge a cost report disallowance backfired on Visiting Nurse Association Health Care Services Inc. in Staten Island, NY.
The VNA is paying $1.6 million to settle Medicare fraud charges, according to a release from U.S. Attorney Roslynn Mauskopf.
The government filed False Claims Act countercharges when the VNA brought a federal court lawsuit to recover disallowed aide costs on its 1995 and 1996 cost reports. The agency "improperly included non-Medicare like costs in calculating the costs of home health aide visits," the release says.
The government based its FCA charges on claims that the agency included "inflated data and false statements in the cost reports," even though the VNA certified on the reports that it "had followed the applicable standards and that [it] had complied with the cost reporting instructions, despite knowingly and intentionally disregarding them," the release notes.
The settlement also covers potential administrative recoupment claims from 1989 through 1994. And the VNA has agreed to drop related legal action and administrative appeals for 1989 through 2000, Mauskopf says. • Hospices may have a lot to live up to if the National Quality Forum gets its way. NQF has endorsed "a comprehensive framework for evaluating the quality of palliative and hospice care; a set of 38 preferred practices for delivering high-quality palliative and hospice care; and 9 recommendations for research to improve upon the measurement and evaluation of palliative and hospice care," says a May 18 release.
The hospice quality measures won't become consensus standards like those that the Centers for Medicare & Medicaid Services was required to adopt for Home Health Compare last fall, NQF spokesperson Phil Dunn told Eli at the time the forum proposed the standards (see Eli's HCW, Vol. XV, No. 9).
Parties can request reconsideration of the recommendations via letter by June 19, NQF says. More information is online at
www.qualityforum.org/news/prPalliativeendorsed05-18-06.pdf. • Members of Congress are working on legislation of interest to home health agencies. Rep. Greg Walden (R-OR), chair of the House Rural Health Care Coalition, has introduced a bill (H.R. 5118) that would extend the 5 percent rural add on for home health agencies through 2011. The legislation also would provide a lump sum payment for rural services provided in the last nine months of 2005--the period after the add on expired and before the Jan. 1 reinstatement by the Deficit Reduction Act of 2005, notes the American Association for Homecare.
And 177 members of Congress asked House Ways and Means Committee and House Energy and Commerce Committee leaders in a May 30 letter to extend the outpatient therapy cap exception process through 2007, according to press reports. A similar letter is circulating in the Senate, the American Physical [...]
