Medicare to target agencies with higher M0175 adjustments.
The HHS Office of Inspector General is keeping M0175 on the front burner.
In its latest semiannual report to Congress, the OIG recaps its reports on the OASIS item regarding prior inpatient stays, emphasizing that home health agencies improperly coded the question on all 400 claims sampled.
Medicare overpaid HHAs $48 million in fiscal years 2002 and 2003 based on incorrect M0175 answers, the OIG estimates (see Eli's HCW, Vol. XV, No. 14). The report fails to mention the amount that Medicare owes back to agencies for underpayments made in Medicare's favor.
Beware: In response to the report, the Centers for Medicare & Medicaid Services agreed to "develop data analysis techniques to identify [HHAs] with significant numbers of claims rejected or adjusted by the new [M0175] payment controls, and then to subject those agencies to corrective action," the OIG notes.
The report is at
www.oig.hhs.gov/publications/docs/semiannual/2006/SemiannualSpring2006.pdf. • The OIG also profiles two home care-related fraud cases in its latest semiannual report to Congress.
Interim HealthCare of Wyoming Inc., Interim HealthCare of Southern Wyoming Inc. and the agencies' owner agreed to pay $250,000 to resolve allegations that Interim submitted claims for Medicare services that weren't provided as claimed and/or were false or fraudulent, the OIG announces. Interim Health-Care and its owner agreed to enter into five-year Cor-porate and Individual Integrity Agreements.
Also, the former co-owner and CFO allegedly claimed his salary in cost report years 1994 through 1998 when he actually was employed full time elsewhere, the OIG says. In a separate settlement agreement, the former CFO agreed to pay $20,000 and to permanent exclusion from Medicare.
Finally, a Colorado RN was excluded from Medicare for at least 60 years following a conviction for causing the death of a home care patient under her care. The nurse also used the patient's credit card to obtain cash and make purchases, the OIG says.
The RN was ordered to serve a life sentence without parole for first-degree homicide, was sentenced to 30 years for aggravated robbery against an at-risk adult, six years for theft, and three years for unauthorized use of a credit card. • Home care providers should be more leery than ever of potential legislative cuts to Medicare reimbursement rates for 2007 and later.
Republicans aren't eager to open up Medicare legislation this session, at least before November midterm elections. But a range of lawmakers are enthusiastic about eliminating the Medicare physician rate cut that is pending, probably in a session after elections, reports The Hill.
Like last year, legislators are considering home care spending as a funding source for the estimated $10 billion physician fix, congressional insiders say. Mem-bers of Congress are also considering eliminating the outpatient therapy caps, at a cost [...]
