Showing posts with label home healthcare. Show all posts
Showing posts with label home healthcare. Show all posts

Wednesday, November 6, 2013

R.I. lawmakers hear from those suffering without in-home service provided by Pentec


Bob Thayer/Providence Journal
Nurse Kelly Florentino, on screen, and Vianna Hurley, of Coventry, listen to testimony about Pentec, a company no longer allowed to offer in-home care in Rhode Island.
PROVIDENCE — The stories were different, yet in one way, they were alike. Each centered around people who were suffering from debilitating diseases and severe pain.
And in each, there was a specialized method of care that made the pain more bearable — until the state Department of Health told the unlicensed company that provided the in-home service to stop.
Testifying before the House Health, Education and Welfare Committee on Tuesday, Jason Scholle, of Narragansett, said the victim in his case was his mother, 59, and now going on 20 years living with multiple sclerosis.
She had benefited greatly from the service, he said, in which visiting nurses provided refills for the pain medication delivery pump implanted in her body. Without those visits, she had to be taken to the hospital for refills, and Scholle said that led to complications that have left her hospitalized and led doctors to remove the pump.
“It really stemmed from her not having help at home,” he said.
Vianna Hurley, 44, of Coventry, said she has had a medication delivery pump for five years and also benefited from the in-home service. But Hurley, who has chronic and acute pancreatitis, said she now has go to Boston for pump refills, typically about once every two weeks.
And Tracy Breton, a retired Providence Journal reporter, told the story of her husband, Doane Hulick, who died of lung cancer last fall but had also benefited from the visits by Pentec nurses to refill and recalibrate his pump.
“Last year, as my husband neared the end of his life, his best friend was his pain pump,” she said.
Breton’s husband died before the state told the company to stop the home visits, but it was Breton who publicized the situation in a Journal op-ed piece that ran on Aug. 25. And committee Chairman Joseph M. McNamara, D-Warwick, said it was that article that prompted an investigation into what led a company that was already operating in 28 states to decide it did not want to operate in Rhode Island.
In testimony at earlier hearings, Health Director Michael D. Fine has said the department was merely following through on an admittedly arduous licensing process that required Pentec to first obtain a certificate of need — meaning the company had to prove its service is needed, affordable and safe.
But Michael R. Abens, general manager of the Pennsylvania-based Pentec Inc., said his company sought a license only to continue helping five patients who had been directed to Pentec by their doctors, not because it made sense from a business perspective. And he described the experience as long and confrontational, so much so that in July, he withdrew the company’s application.
By then, it had already been 10 months since the Health Department had told the company to stop providing its specialized service.
Family members weren’t the only ones to express frustration Tuesday.
Nicholas Oliver, executive director of the Rhode Island Partnership for Home Care Inc., called Pentec’s departure “a preventable mess.” He faulted both sides, saying the Health Department never called his organization to ask if it knew of another provider that could fill in until the day after the committee held its first hearing on the issue. And he said Pentec failed to look for a replacement, a charge Abens refuted.
“We absolutely worked our tails off to find another home health agency,” he told the committee.
Oliver also criticized the Health Department’s licensing process, saying his organization has provided the names of other agencies that are operating without a license, without any apparent response.
“This committee is only scratching the surface,” he said.
McNamara said he will be meeting with representatives from the Health Department and Pentec in the coming weeks, with the aim of bringing the sides together. He said he also expects legislation next year to revamp the licensing process.
“There shouldn’t be a regulatory iron curtain at the borders of our state,” he said.

Wednesday, August 28, 2013

Mobile Doctors CEO, physician charged with Medicare fraud

The head of a Chicago-based company that manages physicians who make house calls and one of its most prolific doctors were arrested Tuesday on charges the company fraudulently billed Medicare for millions of dollars by inflating the level of care given patients.
A criminal complaint charged Dike Ajiri, chief executive officer of Mobile Doctors, with health care fraud and Banio Koroma, a physician who has worked for the company since 2007, with making false statements.
Federal agents raided Mobile Doctors' headquarters in the 3300 block of North Elston Avenue and branch offices in Detroit and Indianapolis and also sought to seize about $2.6 million in alleged fraudulent proceeds from various bank accounts, prosecutors said.
During a brief hearing at the Dirksen U.S. Courthouse, U.S. Magistrate Judge Mary Rowland ordered Ajiri, 42, of Wilmette, held in custody at least until a detention hearing Thursday. Koroma, 63, of Tinley Park, was freed on $50,000 bail but barred from contact with patients.
Before the hearing, Ajiri, a former college football and rugby player, stood with his hands cuffed behind his back, joking with supporters in the courtroom.
Prosecutors said that Mobile Doctors operates in six states, arranging hundreds of thousands of home visits and contracting with doctors who perform the visits. Current and former employees and doctors told investigators that a typical visit with a patient lasts 10 to 30 minutes and is routine in nature.
But according to the charges, Ajiri schemed over the last seven years to increase Medicare billings by falsely claiming the patient visits were more complicated and took longer than they actually did.
A former manager of the Chicago office told investigators that Ajiri set up a system so that the two highest fee codes allowed by Medicare automatically kicked in so that patient visits would be worth the doctors' time and the cost of gas, according to prosecutors.
According to the complaint, the manager quoted Ajiri as telling his physicians, "I don't pay for the ones or twos," a reference to the lower fee codes. From 2006 to 2012, Mobile Doctors received more than $34 million in payments on claims using the two higher codes, according to the charges.
The charges also alleged that Mobile Doctors' physicians falsely certified that patients they visited were confined to their homes, enabling home health care agencies to claim fees for additional services for patients who were not actually qualified to receive them.
Some 16,000 patients had been certified as homebound by the company since 2006, leading to more than 83,000 home health visits, many of them fraudulent, according to prosecutors. Koroma alone accounted for more than 6,000 of the certifications and allegedly billed Medicare for about 17,500 patient visits he made, more than any other Mobile Doctors physician, prosecutors said.

Saturday, May 18, 2013

Home Health Leaders Call for Targeted Program Integrity Reforms to Prevent Medicare Fraud


Published: May 16, 2013 


Read more here: http://www.heraldonline.com/2013/05/16/4868464/home-health-leaders-call-for-targeted.html#storylink=cpy


 — /PRNewswire-USNewswire/ -- On behalf of the Partnership for Quality Home Healthcare - a coalition of community - and hospital-based home healthcare agencies dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation's seniors - Chairman Billy Tauzin (R-LA) and Senator John Breaux (D-LA) made the following statement:
"Yesterday's announcement that the Medicare Fraud Strike Force has charged nearly 100 individuals for allegedly defrauding the federal government for $223 million should prompt immediate action by lawmakers and stakeholders to advance policies that stop Medicare fraud and abuse before it takes place. 
"The government's own data show that abusive billing practices in home health occur in isolated parts of the country where excessive Medicare utilization is taking place. Nearly 90 percent of all improper payments for home health services are occurring in a small number of counties in just five states. Therefore, policymakers should undertake action to address fraud and abuse in a targeted manner.
"Recognizing the critical need to prevent taxpayer dollars from entering criminal hands, the Partnership has been working for more than a year to develop targeted reforms to combat waste, fraud and abuse.
"Reforms called for in the 'Skilled Home Health and Integrity Program Savings' proposal include beneficiary protections that prevent criminals from entering the system and payment safeguards that confirm the accuracy of filed claims to ensure validity prior to payment. Targeted measures have proven to save money, and could have potentially prevented the $51 million in fraudulent payments made to the Miami-based scheme uncovered yesterday.
"As lawmakers look for federal savings, we urge them to take a hard look at how much money is being lost to fraud and abuse and address this national dilemma before asking seniors and honest providers to pay the price.
"We commend the Medicare Fraud Strike Force for rooting out these criminals and look forward to working with lawmakers in Congress to advance reforms that address weaknesses in the Medicare program that allow fraud and abuse to threaten America's seniors, the Medicare program and the nation's taxpayers."
The Partnership for Quality Home Healthcare was established in 2010 to assist government officials in ensuring access to skilled home healthcare services for seniors and disabled Americans. Representing more than 1,500 community- and hospital-based home healthcare agencies across the United States, the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare. To learn more, visitwww.homehealth4america.org. To join the home healthcare policy conversation, connect with us on Facebook, Twitter and our blog. 
SOURCE Partnership for Quality Home Healthcare

Read more here: http://www.heraldonline.com/2013/05/16/4868464/home-health-leaders-call-for-targeted.html#storylink=cpy