• Texas Home-Based Healthcare Agencies Under Scrutiny
  • December 7, 2011 | Author: Juliet M. McBride
  • Law Firm: King & Spalding LLP - Houston Office
  • On December 3, 2011, the Houston Chronicle reported on “Home health care firms breaking rules, raking in Medicare dollars.”  Although the article does not specify any details of alleged misconduct, it states that federal authorities are citing ongoing investigations, and Assistant U.S. Attorney Justo Mendez commented to the Chronicle that some of the company billings in Houston are the result of “fraudsters” who “bill for services not rendered.”

    According to the Chronicle’s investigation, the Medicare program has reimbursed $1.25 billion for home-based health care in Houston over a four-year period, and “nearly every agency that provides nurses, therapists and drugs for the elderly and disabled has violated state and federal standards.”  A representative with the state agency tasked with overseeing home health agencies in Texas, the Department of Aging and Disability Services (DADS), commented that DADS’s investigations focus on the quality of care and when an agency is not in compliance with regulations, the agency is required to provide timely and appropriate corrections.

    Examples of home health agency deficiencies cited by the Chronicle include, among others:  failure to report knowledge of an act of abuse within 24 hours; neglect or exploitation by a worker; failure to ensure that a patient’s care plan is reviewed by doctors; nurses or therapy supervisors failing to make requisite home visits; failure to properly screen for Medicare eligibility; and a lack of written plans to control infection and disease.

    Home health agencies have come under increasing scrutiny over the years, including CMS’s implementation of the 36-month rule in the final 2011 home health PPS rule, at 42 C.F.R. Section 424.550, which limits home health agency ownership changes.