Senate bills calls for home health fraud task force
If a new Senate bill sponsored by Charles Grassley (R-Iowa) is passed into law, OIG will be ordered to set up a special task force to combat home health fraud.
Bill S.255, titled the Home Health Integrity Preservation Act of 1999, would pursue criminal and civil cases against those "who organize, direct, finance, or are otherwise engaged in fraud in the provision of home health services."
The bill, which is before the Senate Finance Committee, also contains a provision that would force home health agencies (HHAs) to offer beneficiaries "a summary of the pertinent findings (including a list of any deficiencies) of the most recent survey of the agency relating to the compliance of such agency." This summary, would, at the discretion of HHS, "also include other information regarding the agency's operations that are of potential interest to beneficiaries, such as the number of patients served by the agency."
"I don't see any benefit to that," replies Gene Tischer, executive director of the Associated Home Health Industries of Florida, the state's trade association. "We're going to have to spend a lot of time explaining this to patients. And most of the problems on the surveys are not health- and safety-related, but paperwork deficiencies."
Tischer fears that disclosing survey results will pressure HHAs into seeking error-free surveys. In turn, they will be much more aggressive in appealing unfavorable findings, which will clog the appeals system.
Grassley's bill also would tighten home health regulation in several areas, including new conditions of participation for home health agencies. For example, HHA managing employees would be required to meet minimum education and work experience standards that would be established by HHS. Managing employees also would have to attest that their agencies have sufficient knowledge of reimbursement rules and the penalties for violating them. The bill also specifies several triggers for additional audits of HHAs. These include high rates of utilization, cost per patient, and overpayments and denials relative to the local areas and the rest of the country.
In addition, home health agencies would have to notify their intermediary and state agencies when they entered a joint venture or opened a branch office. New branch offices themselves would be subject to a special survey, while bankruptcy regulations for HHAs would be tightened.
HHS would have a greater regulatory role under Grassley's bill. The department would devise standards governing the screening of home health employees and the filing of HHA cost reports. It would also study ways of strengthening the physician's role in a beneficiary's plan of care, as well as giving patients a greater voice in planning their care.
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