Federal court rules against provider arguing over director compensation.
A federal court has shot down a bid for medical director reimbursement from a Louisiana home health agency owned by chain LHC Group Inc.
Last February, the Provider Reimbursement Review Board ruled against Lafayette-based Acadian HomeCare when it upheld about $40,000 in disallowances for medical director compensation in 1999 (see Eli's HCW, Vol. XV, No. 15). In a 3-2 split decision, the PRRB sided with intermediary Palmetto GBA because Acadian had 13 medical directors for seven branches and paid two directors for being on 24-hour call.
In its case before the U.S. District Court for the Western District of Louisiana, Acadian argued that "the Medical Directors were not a luxury but a necessity to its goal to provide quality patient care," according to the Court's May 15 decision (06-577). The PRRB decision was "plainly erroneous and ... not rationally supported," the home health agency claimed.
But the Court ruled in favor of the Department of Health and Human Services. "Because the regulations expressly state that these [medical director] services are not reimbursable by Part A in the home health context, the Board was entirely reasonable and rational in disallowing them," the decision says.
Opportunity: For tips on keeping your medical director compensation on the right side of the law, sign up for Eli's Aug. 8 audioconference, "Spot the Compliance Pitfalls Before They Cost You Big," by attorney Robert Markette, Jr. You can obtain information online at
http://www.audioeducator.com/ or by calling 1-800-874-9180. • Home care aides should have the support of federal labor laws that "ensure that the aides, entrusted with the care of the most vulnerable Americans, are treated with professionalism, fairness and dignity," said a June 15 editorial in the New York Times.
The opinion piece ran in response to the U.S. Supreme Court's decision in the closely watched case Long Island Care At Home Ltd. v. Coke, which centered on the question of whether home health agencies are allowed to apply the "companionship exemption" to the Fair Labor Standards Act (see Eli's HCW, Vol. XVI, No. 22). The Court held that the companionship exemption does apply to aides employed by third parties, including HHAs.
The Court's decision "makes no sense for a nation of aging baby boomers," another editorial in the Philadelphia Inquirer states.
Both editorials recommend that Congress revise federal minimum wage and overtime laws to include home care workers. • The HHS of Inspector General took back from providers $2.9 million in Medicare and other federal funds from October 2006 to March 2007. The recoveries were due to alleged fraud and abuse, according to the OIG's latest semiannual report to Congress.
The OIG excluded nearly 1,300 people and organizations from Medicare and other [...]
