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To report Medicare fraud or abuse, you can do any of the following: Call the Medicare fraud tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950. Email: You can also send up to 10 pages describing the incident to HHSTips@oig.hhs.gov.
by Tim Rowan, Editor
While attending three home care conferences over the last two weeks, I had the pleasure of meeting quite a number of agency owners, administrators, sales personnel and intake managers. No matter where each conversation started, it always turned to the challenges of competition and winning one's fair share of referrals. I was astounded to learn that the main problem is not competition, not ineffective sales representatives, but physicians expecting kickbacks.
From metropolitan areas as diverse as Miami, Chicago, and Los Angeles, frustrated owners with high ethical standards bemoan a climate that forces them to either accept a shrinking census or give in and "do as the Romans do" as the only way to survive. One owner spoke of a physician who had a standard rate. "I get 110% of your Medicaid rate," he declared. "Take it or leave it." She left it.
Kickbacks are not the only problem. A number of agency owners said their problem was physicians who override patient choice. It works like this: After a person has been in the hospital for five days or so, he or she has probably been seen by five to fifteen hospital-employed physicians. Each one's familiarity with the patient extends no further than what they can glean from the chart. PCPs and what we used to call family doctors do not do rounds of their own patients in hospitals anymore.
The hospitalist who happens to see the patient on the day of discharge frequently refers to a favorite home health agency or hospice. What makes that agency the doc's favorite? No one ever says. No one ever admits knowing with certainty. But most will whisper, with a knowing wink, about the doctor and the agency owner having the same last name.
Even if a hospitalist distributes referrals fairly to a handful of quality agencies, and has no ownership interest in any of them, problems remain, I am told. It is a two-step process:
I end each of these conversations with the same question, "If a doctor tells you to your face what a referral costs, you know that doc's name and address, don't you? Why don't you turn them in? It's a free call."
Agency owners also end these conversations the same way, "We do. It doesn't do any good. They only seem to be interested in the headline-generating cases that lead to jail time and bring in millions in fines and penalties." They could be right. This week's headline about Amity Home Health Care in San Francisco underscores their point. You never see a news report about a physician arrested for taking a $100 bribe.
This is not a one-time news article. I am not going to let go of this question. I presented the scenario to the Medicare Fraud hot line and am waiting for an answer. In the meantime, let's start a dialog among us. If you have a story like the ones I describe here, send it to me. I'll redact your name and publish the most egregious examples. If you know the worst offender or two in your market area, let me know who it is and I'll compile a list, completely confidentially. Maybe, if we go to the hot line with multiple examples and patterns of behavior, they will pay attention.
Tim Rowan, Editor
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org