Florida May Get HHA Moratorium From Feds

By Brian BandellSouth Florida Business Journal

More of Florida’s home health agencies have questionable billings than any other state, a report found. Now, federal regulators are considering a moratorium on HHA enrollment here.

The U.S. Department of Health and Human Services Office of Inspector General study released Aug. 3 found that 52 percent of the state’s 1,251 HHAs had questionable Medicare billing practices in 2010, compared with the national average of 9 percent. Florida accounted for 25 percent of the HHAs in the nation that were flagged.

Some payments were obviously improper and referred to authorities to recover. Medicare paid $4.8 million for home health services for beneficiaries who were in either a hospital or a skilled nursing facility at the time. An additional $208,311 in claims was paid for home health services performed after the beneficiaries died. For two claims, the beneficiaries had been deceased more than 10 years.

The majority of questionable billing practices the HHS OIG study found concerned the rate of payment and the number of visits. For instance, the median outlier payment to cover extra costs for a patient who required more expensive care was $13, so the study considered anything over $403 per beneficiary to be questionable. It found 1,684 HHAs nationwide exceeded this mark.

Inflated outlier payments in South Florida are a concern. A study by the HHS OIG found home health outlier payments in Miami-Dade County in 2008 were greater than those in the rest of the nation combined.

Attorney Lee Lasris, a partner with Florida Health Law Center, said Florida has more sick, elderly patients than most states, so that could explain some higher outlier payments.

The study also flagged 658 HHAs with three times more visits per beneficiary than normal as questionable.

The state placed a one-year ban on approving new HHAs in 2009. The Florida Agency for Health Care Administration started a program in Miami-Dade County in 2010 where home health workers must phone in to verify that they actually delivered care to the Medicaid recipient. AHCA spokeswoman Shelisha Coleman said this program would likely be expanded statewide.

Kyle Simon, government affairs director of the Home Care Association of Florida, said the one-year ban caused a small reduction the number of HHAs, but they are growing again. Miami-Dade and Broward account for half of all agencies in the state, with Miami-Dade having one agency for every 477 Medicare beneficiaries.

Even during the ban, some would buy HHAs to run up Medicare billings before leaving town, Simon said.

One of the HHS OIG study’s recommendations is a temporary enrollment moratorium for HHAs in Florida and Texas. The Center for Medicaid and Medicare Services concurred. “In developing our approach for implementing the new temporary moratorium authority effectively and thoughtfully, we are in the process of assessing a variety of provider types for suitability for moratoria, including HHAs, and also carefully assessing the geographic area to which moratoria will apply,” CMS stated.

Simon said his association supports a moratorium because it would improve the industry.

Another HHS OIG recommendation is to lower the maximum outlier payments HHAs could receive annually from the current rate of 10 percent. CMS agreed, but will first examine how this would impact small agencies.

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