Dive Brief:
- The U.S. Justice Department is investigating some Amedisys-owned hospice agencies in Massachusetts.
- The Baton-rouge based home health and hospice provider said last Thursday that the U.S. Attorney's office in MA has subpoenaed records for 53 of its hospice patients.
- Records related to Amedisys' clinical and business operations and related compliance activities for its hospices have also been requested.
Dive Insight:
The investigation comes on the heels of a $150-million settlement that Amedisys paid around 18 months ago to resolve allegations that the company had inflated its Medicare payments by providing unnecessary home health treatments and providing home health services to patients who were not homebound. Amedisys said it settled to avoid a lengthy court battle and did not admit any wrongdoing, but the fallout from the suit did culminate in the departure of founder and CEO William Borne (Paul B. Kusserow took over the job in January).
The feds are cracking down on the burgeoning home-health market. As we reported last week, Frienship Healthcare Services, a group of home healthcare providers based in Nashville, has paid $6.5 million to settle a whistleblower case alleging that the company billed TennCare, Medicare and TRICARE for ineligible private nursing services, forged signatures on forms and failed to complete other required paperwork.
Insurers who provide home-health services are also in the limelight. Regulators have expressed concerns that insurers are using at-home diagnosis to inflate patient risk scores. "We remain concerned that in-home risk assessments may continue to be used as a tool to identify diagnoses primarily for reimbursement purposes," CMS said in April.
It might be a good time for providers to conduct their own audits to make sure their documentation will hold up under scrutiny.