Steer clear of reserved bed landmines, OIG warns providers. Hospices shouldn't have to do all the heavy lifting when it comes to compliance for patients in nursing homes. The HHS Office of Inspector General has issued its new voluntary supplemental compliance program guidance for nursing facilities, and the guidance contains hospice provisions. For example: It's a kickback if a hospice nurse provides nursing services for non-hospice patients at no charge, the guidance makes clear. Arrangements between nursing homes and hospices "pose several fraud and abuse risks," the OIG warns. Additional room and board payments, inflated payment rates for contracted hospice services, and referring patients to nursing homes in exchange for receiving their hospice referrals are just some of the kickback dangers the OIG names. Hot spot: Watch out for reserved bed agreements with nursing homes, the OIG adds. They could be a kickback risk depending on how they are arranged. Under reserved bed agreements, nursing homes keep beds open for hospice patients in exchange for payment. The guidance is in the Sept. 30 Federal Register and posted at
http://oig.hhs.gov/fraud/docs/complianceguidance/nhg_fr.pdf. • States could have to fund more home care if a federal lawsuit filed in Florida is successful. Medicaid beneficiaries have filed a suit alleging that the state forces them to reside in nursing homes when they really want home care. The plaintiffs are seeking class-action status on behalf of about 8,500 Floridians, according to the Associated Press. Nursing home lobbyists pressured the state government to make qualifying for home care more difficult, the suit charges. "There are very, very, very few people who cannot be cared for outside in the community," Philadelphia attorney Stephen Gold, who is representing the group, told AP. "Why should the state give a damn whether you put the money in the left pocket of the nursing home or the right pocket of the community?" The 1999 Olmstead Supreme Court decision hasn't provided enough motivation for states to place beneficiaries in home care when appropriate, critics charge. "There's a lot of concern that the nursing home industry is very powerful in many states and has made sure that a lot of Medicaid dollars go to institutional care as opposed to home and community-based care," Toby Edelman, an attorney at the Center for Medicare Advocacy, told AP. The state says the plaintiffs are trying to second-guess the Medicaid program's decisions. • While non-suppliers like physicians and therapists furnishing durable medical equipment won't have to submit to the upcoming Medicare-mandated DME accreditation process, some of them will have some new rules. Next year CMS plans to issue "quality standards designed specifically for anyone furnishing or providing orthotics and prosthetics in order to be reimbursed for such supplies [...]
