Serving the home health, home care and hospice industry since 1999.

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


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.

The Hungry Hospitalist

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.

White Coat Finger Pointing

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:

  1. I will give you this referral but I am not this person's doctor. I will not follow up. I might sign the Face-to-Face document but my involvement ends there. I will not sign the plan of care or write future orders. I will not take your phone calls.
  2. I am this person's primary care physician but I did not make this referral, the hospitalist did. I will not sign the Face-to-Face document. I may take your phone calls and write future orders but I know nothing about what went on during the hospital admission.

Industry Response: "Oh, well."

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.

Next steps

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. One copy may be printed for personal use; further reproduction by permission only.