CMS Calls Moratorium On Home Healthcare Agencies To Preempt Fraud And Abuse
Posted on Wednesday, February 5, 2014 at 11:12AM | Douglas K. Rosenblum
Home health care agencies have existed for decades and most are honest and qualified. What the Affordable Care Act does is deregulate and consolidate just as with the Wall Street banking industry and as with Wall Street the industry is now ready for soaring fraud and corruption in our Medicare and Medicaid Trusts.
THERE GOES YET ANOTHER TAXPAYER FUNDED----PUBLIC ASSET TO FRAUD.
Make no mistake---Medicare and Medicaid has been hit with $200-400 billion in fraud each year since Reagan/Clinton dismantled oversight and accountability but now hedge funds and global corporations are being tied to these home health industry and their sucking machines are on full force. You see, they are in a race because Medicare Trust will be sucked dry in no time. See why the Affordable Care Act builds private health systems designed to take seniors and the poor after Medicare and Medicaid is dismantled?
This is what our Dr Sharfstein and O'Malley have been doing in Maryland for Johns Hopkins and the health industry with Maryland's health care reform and it is why Maryland citizens were closed out and know nothing as to what is happening. As with anything privatized and handed to these national corporations the level of care and qualifications are non-existent for most people using home health services.
The seniors still connected to Medicare and Medicare Advantage may be tracked into home care that works but remember, even you will not have Medicare as it has been very soon. It is being dismantled.
All across the country this is what you are hearing----you won't hear it in Maryland because we have no public agencies looking for this. You can bet the fraud, corruption, and dismal service is just as bad.
Home Health Agencies Charged in Medicare Fraud ...www.nationaljournal.com/healthcare/home-health-agencies... CachedFeb 28, 2012 ·
A Dallas-area doctor and the owners of five home health care agencies were charged on Tuesday with $375 million in fraud against Medicare and Medicaid, the ...
Feds ban new home healthcare agencies in Miami to fight ...www.miamiherald.com/...ban-new-home-healthcare-agencies.html CachedJul 26, 2013 ·
Amid concern about rampant Medicare fraud, an unprecedented moratorium was imposed on new home healthcare agencies in Miami-Dade.
Seven Arrested, Charged with $22 Million Detroit-area Home ...www.justice.gov › Briefing RoomJan 17, 2013 ·
Seven Arrested, Charged with $22 Million Detroit-area Home Health Care Fraud Scheme. ... as part of the Medicare Fraud Strike Force, and IRS-CI, ...
As I have said earlier----when people like Sharfstein and his deputies in Health and Mental Hygiene are confronted with the need to stop fraud they say just what Johns Hopkins and Obama say-----THERE IS NO FRAUD. The deregulation and dismantling of the public health structures guarantee Maryland health care will decline rapidly.
Maryland mirrors Texas in dismantling oversight and accountability and handing all business to global/national corporations which then feed on public money and individual's wealth. What Sharfstein did was decide which hedge funds and corporations were going to be hooked to the Medicare and Medicaid feeding trough......We have the Carlyle Hedge Fund with our Manor Care and defense industry corporations owning hospitals and profits are soaring.
THIS IS WHAT THE AFFORDABLE CARE ACT DOES----IT DISMANTLES OUR PUBLIC SECTOR HEALTH, CONSOLIDATES SO BIG PROFIT-DRIVEN CORPORATIONS CONTROL ALL HEALTH CARE IN YOUR STATE.
Think expanding Medicaid funding was for the good of the American people or with massive Medicaid fraud does it simply move more Federal money to global corporations through fraud and corruption? THAT'S RIGHT-----
EXPANDED MEDICAID ONLY SENDS MORE FEDERAL MONEY TO BE FLEECED----IT HAS NOTHING TO DO WITH PEOPLE ACTUALLY GETTING HEALTH CARE.!
Home health care firms breaking rules, raking in Medicare dollars
By TERRI LANGFORD, HOUSTON CHRONICLE | December 3, 2011 | Updated: December 3, 2011 10:11pm
More Information HOUSTON'S HOME HEALTH CARE TALLY
American taxpayers spend tens of millions of dollars on Medicare
$1.25 billion: Medicare money paid to Houston area agencies over four years.
$334 million: Amount paid in 2010.
468: Number of companies in Houston region.
129: Number of companies paid at least $1 million in 2010.
289: Number of companies receiving at least $1 million between 2007 and 2010.
Source: Chronicle analysis of Centers for Medicare and Medicaid Services data
The nation's Medicare program has dished out $1.25 billion for home-based health care in Houston over four years - and yet nearly every agency that provides nurses, therapists and drugs for the elderly and disabled has violated state and federal standards, a Houston Chronicle investigation has found.
Still, little stops the flow of taxpayer dollars to the nearly 470 companies based in America's fourth largest city.
Dubbed "deficiencies" by the Texas Department of Aging and Disability Services, they include violations like failure to make sure drugs and treatments are administered properly and failure to report abuse of a patient.
Federal authorities say not only are companies falling short on certain standards of care, some also are bastions for potential fraud - its victims patients and taxpayers.
Though federal authorities declined to provide details, citing ongoing investigations, Assistant U.S. Attorney Justo Mendez told the Chronicle that some of the company billings in Houston are the result of "fraudsters" who "bill for services not rendered."
Earlier this year, Houston's Craig O'Connor was witness to the wiles of the industry.
His elderly mother, suffering from a poorly healed wound on her foot, was sent home from the hospital with a recommendation to use a home health care agency to help her recovery. Instead, he says his mother's convalescence was turned upside down as workers from the recommended company made a beeline to his mother's door.
"This was my first experience with Medicare, and I quickly became alarmed about all the doctors and health aides who were practically falling all over themselves to schedule house calls to see my mother," O'Connor recalled.
One of the "doctors" who showed up wasn't even really a doctor, he said.
Federal auditors repeatedly have noted the exploding and profitable growth of home health care in the Lone Star State, where Medicare spending has blown up to three times the national growth rate.
The Chronicle's examination of payment records showed that even in the tiny town of Edinburg in South Texas, 27 home health care agencies have received $331 million over the last four years.
Two months ago, a Chronicle investigation of the private ambulance business found millions in Medicare dollars spent on questionable transports of able-bodied patients to mental health clinics.
Houston's Harris County leads the nation in the number of nonemergency ambulances, companies and Medicare billings with more than $62 million coming to some 400 companies in 2009 alone.
And yet, the home health care industry is even larger - and richer: $384 million was paid to 468 Houston companies in 2010.
Like private ambulances, no one state agency is charged with determining how much money is too much, or how many companies are too many. And Medicare's direct contact with the companies that bill the mammoth insurance agency for the elderly and disabled is minimal.
The Centers for Medicare and Medicaid Services, or CMS, delegates nearly all of its authority to contractors, a mix of private companies and state agencies. Those contractors, not the federal agency, decide what companies qualify for Medicare and pay the patients' bills.
In Texas, it's the state Department of Aging and Disability Services, or DADS, that does the licensing, inspecting and investigating of home health agencies - a chore it is contracted to do for Medicare as well.
If the agency finds federal violations that endanger a patient's health, the report is sent to CMS and a "termination track" clock begins. The company has 90 days to correct the problems, with DADS in charge of checking back.
Through all of this, however, no one from the $760-billion CMS ever sets an eyeball on a home health agency in Houston, where 289 companies have collected $1 million or more from 2007 through 2010.
Last year, 129 companies hit the $1 million Medicare mark.
When asked exactly how many agencies in Texas with federal violations end up on Medicare's "termination" track, CMS' Dallas spokesman Bob Moos referred the question back to Texas authorities.
"We're not aware of any Texas home health care providers on a … termination track at the moment, but, frankly, DADS will have a better handle on this, since it's the one that actually does the inspections," Moos said.
Home health care agencies say they're being overly scrutinized because of fraud in the industry, with nearly every agency getting dinged for infractions that aren't that serious.
"I respect the home health industry's position on this, but we're not going to let up on them," said DADS Commissioner Chris Traylor. "Our job is to hold them accountable for any violations we find, and that won't be changing."
The hundreds of deficiencies run the gamut from the bureaucratic, like missing paperwork, to the problematic: not reporting within 24 hours knowledge of an act of abuse, neglect or exploitation by a worker; failing to make sure a patient's care plan is reviewed by doctors; nurses or therapy supervisors not making home visits when required; not checking properly for Medicare eligibility; and lacking written plans to control infection and disease.
But if no agency is about to be terminated and risk losing tens of thousands, if not millions of dollars in Medicare money, why have an inspection system?
"Our top priority is the health and safety of the clients," said DADS spokeswoman Cecilia Fedorov. "Our investigations focus on the quality of care provided and when we find that an agency is not in compliance with regulations, we require timely and appropriate corrections."
Last month, the U.S. Department of Health and Human Services' Office of Inspector General reported that contractors charged with detecting fraud have had a series of problems that "affected their ability to identify potential fraud and abuse" and track the collection of overpayments.
"The government has enough information that they should be able to find this stuff. They ought to go look," said Rachel Hammon, director of clinical practice and regulatory affairs for the Texas Association of Home Care & Hospice. "I think the big problem I see is how the various government agencies coordinate. Each one says 'That's not what I do' or 'I'm not funded.' "
Some health care agencies counter that they're made scapegoats by the inspections as both state and federal agencies are pressured to do something about the nation's soaring Medicare bills.
'I go by the rules'
Edna Lewin, administrator of The Trend Health Care Services, says violations do not mean home health agencies or their workers are not safe.
The 32 "deficiencies" her company received in 2009 - the most by one company in Houston - were all corrected.
"You need to know the story," she said. "I live above-board. If I didn't, I wouldn't be in business."
Dorothy Smith, a registered nurse who created her Lanoitan Home Health Care of Texas in 1978, was cited for 21 deficiencies last year, all of which she says were corrected immediately.
"If you look at my record, it's superb," she said. "I think I'm getting the flak because there's so much fraud in home health care. I refuse to be a part of it. I'm old school. I go by the rules."
In 2009, the General Accountability Office reported Medicare's spending on home health care totaled $12.9 billion in 2006, up 44 percent in 2002.
It also zeroed in on several problems, some in Houston, including home health care agencies' propensity to overstate a patients' condition in order to get Medicare money. Nearly 700 patients deemed most severe "were served by potentially fraudulent (home health care)," the audit stated.
Federal officials in Houston also are investigating kickback schemes and billing for "services not rendered" but could not comment on specifics.
"Law enforcement's efforts alone will not stop this fraud," said Elvis McBride, who supervises the FBI's Health Care Fraud Task Force in Houston. "It takes CMS or Medicare to put edits in place to prevent certain types of payouts. It takes education (for Medicare patients)."
Even before Houston's explosive growth in home health care, federal auditors noted that not only had the number of people getting Medicare benefits doubled, but so did the number of times agencies billed for a visit to a patient: from 36 times to 73.
"I have a problem with the government not watching who is billing what," said Anita Bradberry, executive director of the Texas Association of Home Care & Hospice. "It's not that home health is bad. Home health is the solution to a lot of our health care problems."
Johns Hopkins is of course leading in the Home Health Care Industry here in Baltimore and Maryland with headquarters conveniently located in a tax-free zone. It not only has its own home health corporation-----it controls how money is dispersed to Medicare and Medicaid corporate non-profits----POWER TO THE CORPORATIONS! So, who does Hopkins want to create start-ups that will then be allowed to fleece the system?
Keep in mind, neo-liberals are sending more Federal funding to Medicaid even as they dismantle and privatize Federal Medicare and Medicaid. THE AFFORDABLE CARE ACT IS ALL ABOUT PROTECTING THE HEALTH COVERAGE FOR THE POOR SAY NEO-LIBERALS AND NEO-CONS! See why Republican states like Florida and Tennessee jumped for Medicaid expansion? Think of the number of baby boomers heading into this mess with health care deregulated and private corporations free to provide the least of care.
THIS IS WHY THE US SPENDS THE MOST ON HEALTH CARE WITH THE LEAST QUALITY------IT IS STOLEN.
This is what O'Malley, the Maryland Assembly, Baltimore City Hall are creating for you-----neo-cons and neo-liberals dismantling all that is public and handing it to global corporate profit! Don't vote Republican----this is Republican policy! In Maryland we have no Department of Labor, Licensing, and Regulation so Maryland wants all that money paid for licensing and then does not care what these businesses do. That is why fraud and corruption places Maryland at the bottom nationally.
THIS IS BROUGHT TO YOU BY THE SAME PEOPLE RIGGING MARYLAND ELECTIONS TO MAKE SURE THE SAME CROOKED POLS STAY IN OFFICE!
Neo-liberals are selling this as 'cost effective and best for the patient' to stay at home for care------but they have no intention of seeing people get quality home care----they simply want these people out of a profit-driven health industry. If you can afford the gold and platinum plans or the ever-rising Medicare Supplement insurances you may avoid this but 80% of Americans are already slated for the Medicaid-level.
AND YET, LABOR AND JUSTICE LEADERS KEEP SUPPORTING NEO-LIBERALS EVERY ELECTION. TAKE BACK THE PEOPLE'S PARTY BY RUNNING AND VOTING FOR LABOR AND JUSTICE!
Blistering inspector general report says feds are failing to fight Medicaid home care fraud
IG has repeatedly warned Centers for Medicare and Medicaid Services about personal services program for home care
By Joe Eatonemail 12:01 am, November 15, 2012 Updated: 12:19 pm, May 19, 2014 Jasmine Norwood/
The Center for Public Integrity
Like a growing number of disabled Americans on Medicaid, Keith Foreman, a 57-year-old in Metropolis, Ill., qualified for a personal caregiver to help him with daily activities like dressing, shaving, and preparing meals.
Foreman, who prosecutors say suffers from a spinal injury, hired his girlfriend, Sheila McDonald, for the job. In 2011, McDonald received almost $5,000 from Medicaid for six months of care she provided to Foreman.
These personal care services, which are available in all 50 states, are designed to help the sick, elderly, and disabled remain in their homes — and out of expensive nursing facilities. But Foreman was not living at home. During the days marked on McDonald’s timesheets, Foreman was housed in the Massac County jail in Illinois, serving time for forging a stolen debit card signature at a local liquor store.
Like Foreman and McDonald, who both pleaded guilty to charges of making false statements, unscrupulous beneficiaries and home health workers are increasingly targeting personal care services programs for illegal money-making schemes, according to a new federal report. Investigators say lax requirements for both caregivers and patients, along with poor state and federal oversight, has made the rapidly growing programs a lucrative target for fraud. And this isn’t the first time they’ve issued such a warning.
Report faults federal oversight of state programs A Health and Human Services Office of the Inspector General (OIG) report scheduled to be released today faults the Centers for Medicaid and Medicare Services (CMS) for inadequate oversight of personal care services programs, whose costs are shared by states and the federal government, as is the norm for Medicaid. The report, which brings together six years of OIG investigations and 23 reports on the topic, describes a program hindered by poor claims documentation, insufficient monitoring of claims data for fraud and waste, and a crazy-quilt of varied requirements for personal care workers in different states.
“Historically, CMS has left a lot of the responsibility for overseeing waste, fraud and abuse to the states,” said Christi Grimm, special assistant to the principal deputy inspector general. “As a result, we have 301 different sets of requirements for caregivers across the states.”
Although some states mandate criminal background checks and licensing for home health workers, Grimm said others lack even the most basic requirements, including age minimums, which has led to cases in which juveniles escape prosecution for fraud and abuse. Worker requirements are set by counties in a number of states, she added, which has led to a hodge-podge of rules that are difficult to enforce, and nearly impossible to monitor.
“We are asking CMS to step up to the plate,” Grimm said, and use its authority to regulate and monitor the state programs.
The report includes six previous OIG recommendations to CMS and state agencies which have gone unimplemented. In a 2008 report that found five states may have paid up to $11 million in error for personal care services during one quarter of 2005, OIG recommended that the CMS work with states to stop payments for personal care when patients were receiving care in institutions, not at home. The agency agreed with the recommendation, but according to the OIG, the work has not been completed.
In addition to asking the agency to address previous recommendations, the report offers four new goals for CMS to improve oversight and monitoring of state plans, including standardizing rules for personal care workers to set minimum age and education levels, and require criminal background checks.
The report, however, seems unlikely to spur the agency to follow the OIG’s specific suggestions.. In a written response, CMS — part of the Department of Health and Human Services — explicitly concurred with only one of the OIG recommendations: that it should provide states with claims data to help root out cases in which beneficiaries are simultaneously receiving both institutional care and home health services. In response to the recommendation on establishing federal guidelines for personal care workers, CMS pointed out there is a shortage of care attendants.
“Personal care services are an important part of keeping people in their homes and out of nursing homes, which lowers costs and improves the quality of life of the patient,” said CMS spokesman Brian Cook. “We are working to protect personal care from fraud and abuse by promoting stronger training programs for workers who provide personal care, working with states on background check programs for these workers, and developing new data methods to analyze claims for potential fraud and abuse."
Grimm called the CMS response to the report unacceptable. “It’s not uncommon for CMS … to identify things on the horizon, or things they hope to do, but not necessarily commit to doing something,” Grimm said, adding that CMS’s efforts so far simply have not worked. “[CMS] has the authority to do what we are asking. It has not done it yet. And it hasn’t committed to doing it after reading our report.”
A wealth of opportunities
According to investigators, most fraud schemes in personal care services involve billing for care that was not provided or was not allowed. Self-directed programs, which allow beneficiaries to hire and manage their helpers, may be particularly vulnerable, but some prosecutions have also involved home health care agencies.
In January, for example, the owner of a Minnesota home health care company outside Minneapolis was sentenced to two years in prison for cheating Medicaid out of more than $650,000 in charges for personal care services. In March, the owner of Families First Home Health Care in Sparta, N.C., pleaded guilty to fraud and money laundering stemming from a scheme in which she billed Medicaid for personal care services she did not perform and split the proceeds with plan members.
“Fraud goes where the money is,” said Barbara Zelner, executive director of the National Association of Medicaid Fraud Units, which represents state law enforcement agencies that investigate Medicaid fraud. After nursing homes, Zelner said, home health represents one of the larger slices of state Medicaid budgets.
Personal care services programs have grown quickly since a 1999 Supreme Court decision held that unjustified segregation of the disabled is a civil rights violation. The ruling led to increased spending for home health services; in 2011, Medicaid paid more than $12 billion for personal care services, up 35 percent since 2005, according to the OIG. Investigators say program fraud has kept pace. In 2010, state Medicaid fraud units investigated more than 1,000 cases involving personal care services, more than any other type of Medicaid service.
Not everyone agrees with the OIG’s views on personal care services. In 2011, an OIG review of Medicaid claims for personal care services in New Jersey found that 40 percent should have been denied. Sherl Brand, president of the Home Care Association of New Jersey, which advocates for home health care providers, questions the OIG’s work, saying the agency often draw broad conclusions from examinations of a limited number of claims. “It is almost a bit ridiculous because of the extrapolation they do,” Brand said.
New Jersey home health workers face criminal background checks and certification and licensure requirements, Brand said. Personal care services programs save money, she said, in addition to helping disabled people live better lives. When New Jersey was faced with budget cuts, Brand said the association determined the average weekly cost for personal care services was $242 dollars a week, only slightly higher than the cost of a single day in a nursing home.
But as funding for the programs increase, fraud follows. Kirk Ogrosky, a former top federal health care fraud prosecutor who is now a partner at the Washington law firm Arnold & Porter, said home health has long been a hotbed of fraud, both in Medicaid and in Medicare. The fraud, he said, is not hard to uncover. Ogrosky recalled that after an extensive analysis of Medicare claims, he sent agents out to interview questionable beneficiaries. When the agents knocked on the doors, they often learned the person they were looking for was at work, Ogrosky recalled. “That’s utterly preposterous,” he said, “since home health requires that you are homebound.”
In other cases, Ogrosky said, agents found that home health care agencies were filing claims for beneficiaries who did not live at the homes indicated on the claims. “One of my favorite stories is about a homeless guy we found,” Ogrosky said. “He didn’t even have a home to be homebound to.”
Maryland is ground zero for what will be a home health industry mirroring the subprime mortgage corruption of the housing industry. There are so many home health care companies------all with a level of administration-----medical supplies------for-profit career education------and much of it is paid for from Federal/state taxpayer education funding and/or Medicare and Medicaid Trust money. We are being fleeced of education money for these career centers that are a dime a dozen in Maryland all funded with 'higher education' money. Doctors used to train their own receptionists, medical aids, file clerks but now there is a career training for that. Think of the level of education funds going to this home health care industry----all paid with 'higher education funding'----and sending people off with a level of training that allows them no ability to meet the needs of most health consumers. These home health workers will tell you they do not even have a nurse to call for help because that is all hype----one nurse shared between several different home health agencies
-----ALL HAPPENING BECAUSE PUBLIC HEALTH IS NOW A CHEAP-FOR-PROFIT BUSINESSES.
State nursing homes centralize all of this at such a level of cost less than what this outsourcing filled with fraud is creating. The staff was professional and patients had the benefit of other people around them. What happened in Maryland is state nursing homes were defunded and allowed to become bad environments.
IT WAS THE DEFUNDING THAT MADE PUBLIC NURSING HOMES UNINVITING FOR PEOPLE----NOT THE PUBLIC STRUCTURE.
So, neo-liberals and neo-cons are doing to health care what has happened in the financial services industry-----hundreds of different kinds of banking all geared to fleece you.
Keep in mind that many seniors are navigating all of this on their own and many are not good advocates for themselves----which neo-liberals know. So, there is so much abuse and neglect
THAT EVERYONE KNOWS WOULD HAPPEN WITH THIS KIND OF HEALTH STRUCTURE! IT IS RIDICULOUS!
Dealing with a loved one with health challenges while fighting a system as corrupt as banks-----yeah----that's what the American people want.
The more you know your rights as you see below---the faster they will hit and run. All of this so corporate pols do not have to send taxpayer money to support public nursing homes. Note this complaint below is from our good old neo-liberal Senate Leader Harry Reid's state of Nevada
Complaint Review: INTEGRITY HOME HEALTH CARE
If you are considering a quality ethical and caring Home Health Company DO NOT choose this company. The staff provided appear to be of good quality but the office staff is the worst most corrupt and incompetent types you'll ever find.
Don't be fooled by that sales technique the Community Liason Jay Heiseler tells about the owner Alysa Sigmund who he claims lost her father due to very poor, uncompassionate and inadequate care provided her father via a certain Home Health and later Hospice Care.
He claims it was this experience that inspired Alysa Sigmund (Owner/Administrator) to create her own quality Home Health Company. Jay also likes to tell stories about how Integrity Home Health Office Staff GO ABOVE & BEYOND for their clients that all they do is Client Oriented and they are aware of HOW MUCH MONEY they are paid from Medicare/Medicaid and are mindful of providing the Absolute Maximum Services they can provide for the client considering that budget EVEN IF THEY MAKE VERY LITTLE PROFIT.
Mr. Jay even states they will advocate and fight the insurance companies for coverage or extended coverage and aren't afraid of submitting Prior Authorizations requests to Secondary Insurance like Nevada Medicaid to make it happen, because again they CARE ONLY ABOUT THEIR CLIENTS NEEDS.
Well here's my experience with these people having acted as representative for an elderly bed confined family member with multiple conditions that used their service. Alysa Sigmund is a cold hearted individual whose ONLY CONCERN IS TO MAKE MONEY.
Speaking to this lady you quickly find that she sounds more like a witch rather than an angel and that Mr. Heiseler story is probably a convenient lie and ploy to trap people into trying this lousy service.
In this case despite there is No Mandate by Medicare & Medicaid to obtain a copy of the Power Of Attorney from the representative(s) for Home Health Services to continue when there exists Doctors Orders that the patients requires them this woman Alysa Sigmund constantly harasses and begins to threaten discharge or reduction of services that are NOT ACCORDING TO MEDICARE/MEDICAID GUIDELINES or anything that would indicate NON COVERAGE.
In our case the client was under the care of FAMILY CAREGIVERS where a Next Of Kin was present. A Power Of Attorney does in fact exist but is kept at a safety deposit box at a local bank and considering the patients needs are 24/7 made it inconvenient to go retrieve it just to give a copy to this hateful individual.
Anyone that has any understanding of HIPAA should know there are alternative ways of establishing credentials or authority to discuss or direct care of an incapacitated individual especially in the case of a family member and next of kin at that.
Furthermore my loved one was with this agency probably 4 weeks during which times certain promises by Jay and the Nursing Supervisor as to the amount of coverage for her care by an RN were NOT PROVIDED.
She had been discharged from her last hospital stay requiring MULTIPLE SKILLED FUNCTIONS to be performed by a RN such as IV Infusion Antibiotics, Care of a Picc Line, Nephrostomy Bag and its care, Foley Catheter, Tube Feedings, multiple skilled dressing changes including wound care (skin breakdown/sores) o2 monitoring/bipap administration, blood thinning by injection, just to name a few.
The so called promises that an "RN would be staffed EVERY DAY for the First Week" DIDNOT HAPPEN. Alysa was attempting to deny a CNA on the pre-tenses of a a family member serving as PCA which is ERRONEOUS & PURPOSEFUL TACTIC utilized to pocket a greater Share of the Medicare/Medicaid moneys.
Medicare is the Primary Payer and Medicaid Secondary Payer, Medicare covers FIRST the Maximum number of Home health Aide (CNA) visits the patient requires per Doctor orders in conjunction with Family Cargiver input and THEN MEDICAID COVERS ADDITIONAL TASKS BY AWARDING TIMES TO THE PCA.
In the case of a bed bound individual who is incontinent for both bladder and bowel a patient may need to undergo MORE than 2 Bed Baths per day and there is NO "Duplication Of Services" BECAUSE THE PATIENT REQUIRES THE INCREASED AMOUNT OF CARE. People who have common sense or any remote medical training and been exposed to the realities of the bed bound patient who are prone to skin breakdowns due to the chemical reaction of stool plus urine touching the skin for extended periods of times know what I'm talking about here.
In addition Alysa Sigmund was attempting to DENY all Therapy Services such Physical Therapist, Occupational Therapist and ultimately only provided 2 visits from a PT. Mrs. Alysa Sigmund stated that in the case of a bed confined contracted individual MEDICARE DOESNOT PAY FOR THERAPY SERVICES because "IT WOULD BE A WASTE, SOMEONE LIKE THAT WON'T IMPROVE AND WE NEED TO DOCUMENT MARKED IMPROVEMENT."
Speaking to anyone who has done their own research on this subject you will find a wealth of information available through the Centers For Medicare & Medicaid website that gives you access to PUBLIC INFORMATION such as the Medicare Manuals and CODIFICATIONS OF FEDERAL REGULATIONS in addition to Medicaid State Plans, and approved Medicaid Waivers. DONOT be fooled by these unethical companies who are only in the business to MAKE MONEY who attempt to Defraud and Insult your intelligence with Absurd Falsities as to Medicare/Medicaid Insurance Coverages.
Alot of these companies operate under the "PLATEAU MYTH" principle that is to say they claim that Medicare/Medicaid will ONLY pay for Physical & Occupational Therapy only when DRAMATIC/MARKED IMPROVEMENT can be documented objectively on paper.
However, reading the Medicare Regulation Manuals regarding Home Health will reveal to you that Medicare DOES IN FACT pay for Therapist involvement to formulate and administer a "MAINTENANCE PROGRAM" designed to PREVENT FURTHER DETERIORATION AND TO AVOID THE LOSS OF ANY IMPROVEMENT GAINED VIA THERAPY INTERVENTIONS.
The CFR specifically mandate the PT & OT to stay on the case to REGULARLY MONITOR the condition of the patient to ENSURE that those Family Caregivers they have trained to provide Therapy/Range Of Motions on behalf of the patient are AVOIDING any Further Deterioration to their Limbs and ACTUALLY SUSTAIN ANY IMPROVEMENTS in RANGE OF MOTION ACHIEVED.
Also keep in mind that per the Medicare Regulations Local and National Coverage Determinations and the CODIFICATION OF FEDERAL REGULATIONS MULTIPLE PHYSICIANS can order Therapy based on Multiple Reasonings or Conditions and the Therapy Services can be provided by more than one company and or combination of Therapists EVEN CON-CURRENTLY.
Ultimately what happened is that Alysa Sigmund DUMPED my loved one WITHOUT ANY HOME HEALTH COVRAGE and WITHOUT NOTIFYING HER PHYSICIAN and to us she committed a most DESPICABLE and UNETHICAL ACTION and that was the issuance of a Home Health Advance Beneficiary Notice that stated they were REDUCING or or Discontinuing Skilled Nursing, Phyisical Therapy, Occupational Therapy, Home Health Aide, Medical Social Services with the reason: "Non Compliance With Medicare Rules" containing 3 other suggested Home Health Companies and in ADDITION a "Notice Of Medicare Provider Non-Coverage" which were BOTH DATED THE EXACT SAME DAY as the Hand delivery by the assigned RN Nurse!
Anyone that is familiar with BIPA legislation (Benefit Improvement Protection Act) knows that the Home Health Company is mandated to provide the Notice(s) 48 HOURS BEFOR THE EFFECTIVE DATE. This allows you to request a Fast Track Appeal through the QIO whose deadline is 12:00 Noon on the DAY BEFORE THE EFFECTIVE DATE. I have not even mentioned the various violatons committed against ADA, Olmstead and Nevada Revised Statutes concerning quality medical care by such organizations as a HOME HEALTH.
In other words this was a conspiratorial and PRE-MEDITATED evil act to NOT only Discharge the Client but to attempt to REMOVE ANY APPEAL RIGHTS. I did contact the QIO on the Exact Same Day and the Home Health Company subsequently FAILED after being contacted by QIO to provide the MANDATORY "DETAILED NOTICE" by the END OF THAT BUSINESS DAY.
We are therefore taking steps to submit reviews Online for all those diligent researchers who are looknig for a Home Health Company for themselves or a loved one so they can know what type of Company this really is because "INTEGRITY" they DONOT HAVE. We are also filing a complaint with the Better Business Bureau, The Bureau Of Licensure & Certification, Medicare, CMS, Regional Home Health Intermediary and may contemplate civil actions.
Las Vegas, Nevada