Prevalence of abuse, fraud stories in the media frighten elderly clients
September 1, 1997 4 minutes read
Prevalence of abuse, fraud stories in the media frighten elderly clients
Private duty agencies need to establish ethics, community outreach
Media reports about fraud and abuse allegations in home care are hitting their mark; some agencies are reporting that frightened clients, especially elderly ones, are considering canceling service."Elderly patients have called [their providers], saying they were concerned and felt they needed to terminate their service," says a staff member of the Kansas Home Care Association in Lawrence.
"They said they didn’t want to be involved in any fraud or abuse," she adds. Most patients have calmed down after talking to their providers about the media reports.
"It’s a negative specter in the public’s image," says Eric Sokol, assistant director for government affairs for the National Association for Home Care in Washington, DC.
Although much of the publicity refers to Medicare fraud allegations, many people see the words home care and apply it to all parts of the industry, including private duty. "The reports might turn them off of the benefit or the utilization of the benefit, or give them the false impression that the benefit is not cost-effective," he says.
In response to the criticism, providers are reaching out into the community in a flurry to talk about the benefits of home care. Some ways they are reaching out include:
letters to the editor of local newspapers;
conversations about the reports between staff and clients during visits;
speeches at community organizations, such as Rotary;
letters to clients;
appearing on radio talk shows;
statements from home care organizations responding to the reports.
"We need to put a personal touch to home care," says Sara Speights, director of government and public affairs for the Texas Association for Home Care (TAHC) in Austin.
Agencies need to talk about the reports with their clients, so clients don’t think the providers are hiding anything. "Ignoring the reports doesn’t do anyone good," says a Kansas Home Care Association staff member.
But before private duty agencies tout their industry’s ethical practices, they need to be sure they have set up standards in their own agencies, says Linda Donev, a consultant with Home Healthcare Architects in Boca Raton, FL.
Staff should have a place — maybe an ethics committee — to report suspected fraudulent or unethical practices and know the claims will be investigated, she says. "For example, staff may suspect that a nurse is not documenting appropriately, that she’s not providing the services she says she is providing. There should be an internal mechanism for agency staff to make reports so that those findings can be investigated."
Once these standards are in place, it is easier to promote your ethical practices. "The pattern of dealing with ethical situations gives your agency a certain standing in the community."
The fallout from the reports still remains to be seen. "It’s beginning to affect policy-makers and regulatory department officers, which is worrisome," Speights says. "People are going to believe what they see day after day."
Some of what clients are seeing in the media include:
a recent hearing of the U.S. Special Committee on Aging at which the General Accounting Office (GAO) in Washington, DC, released a study asserting that 40% of Medicare payments made for home health care in California, Illinois, New York, and Texas between January 1995 and March 1996 should not have been made, due to clerical errors, insufficient information, and possible fraud;
indictments of executives from Columbia/ HCA in Nashville, TN, and Mederi in Miami for defrauding Medicare;
an audit of the Health Care Financing Administration’s (HCFA) 1996 fiscal year statement that reveals a massive number of improper payments, including home care payments to health care providers participating in the Medicare program.
Providers assert the reports are unfair. "First of all, these reports fail to make any distinction between intentional fraudulent activity and technical noncompliance with the law," says Sokol. "It does not bode well for the public image."
TAHC released a statement that said claims made by federal investigators that fraud and overcharges are widespread in the home health care industry are exaggerated and misleading.
"Clearly, we are concerned about any fraud or abuse that exists in home care or any other area of the health care industry, and we support reasonable measures to eliminate these problems," says Speights in the statement. "However, sensationalizing reports of these problems harms all parties — the Medicare program, the home care providers, and most importantly, the patient."
Disputing the accuracy of the OIG and GAO studies, TAHC says that HCFA’s own data indicate that in 1995, out of more than 300 million visits rendered, 0.2% of home health visits were denied on the basis that they were not deemed necessary. In addition, most denials are overturned on review — 40% of denials are overturned during re-review by Medicare intermediaries, and 80% of denials are reversed on appeal in the courts.
"We are concerned about the manner in which the Senate’s Special Committee on Aging conducted its hearing," says Speights. "The home care industry was not given a chance to review or respond to studies done by the OIG and the GAO before they were released, nor were we allowed to deliver oral testimony. Had we been given these opportunities, we believe that the information contained in the studies would have been more balanced and would have resulted in a different analysis."
(Editor’s note: The proposed pilot project in the Medicare program involving medical savings accounts was included in the signed budget. The project allows about 390,000 people to try medical savings accounts to purchase catastrophic-care insurance — with annual deductibles as high as $6,000 — instead of traditional Medicare. For more information about medical savings accounts, see the August issue of Private Duty Homecare, p. 85.)
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