According to a recent investigation conducted by the Houston Chronicle, Houston-based home health care firms are in constant violation of state and federal regulations, yet, tax-payer money is still being shelled out to cover their expenses. The home health care industry in Houston is racked with “deficiencies,” as they are called by the Texas Department of Aging and Disability Services, which can range from failure to ensure the proper dispensation of medication to suspicious billing practices.
The Chronicle highlighted the story of one Houston man, Craig O’Connor, who experienced first-hand the greed of the home healthcare industry in his city. A Houston hospital discharged O’Connor’s mother after a recommendation that she be treated by a home healthcare agency, which the hospital recommended. After the discharge, O’Connor’s mother’s home was bombarded with visits and calls from the recommended agency. “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” said O’Connor.
The article noted that the home health care industry in Houston has earned nearly $400 million in Medicare money in 2010 alone and most of these billings are questionable. A previous investigation by the Chronicle found several private ambulance companies employing questionable and possibly fraudulent billing practices.
However, Medicare itself does not have much direct contact with these home healthcare companies. The Center for Medicare and Medicaid Services (CMS) is the governing body that houses the federal Medicare program. It delegates its licensing responsibilities to private companies, and in Texas, that agency is the Texas Department of Aging and Disability Services (DADS). DADS is responsible for monitoring the home health care companies to ensure they comply with all federal and state regulations. DADS officials say that it will continue to keep the pressure on the home healthcare industry and report any companies that are not complying with federal and state regulations.
There is a process by which DADS reports a healthcare company that is in violation of regulations. That company is first placed in the CMS termination track. The violating company has 90 days to correct the problems that resulted in the violation and DADS is responsible for checking for compliance after that 90-day probationary period has expired. Even though this process exists, the Chronicle notes that no one from CMS has ever personally investigated some of the suspicious practices occurring in Houston.
The billing practices are suspicious, but fraud investigators have had difficulty finding anything that would amount to a prosecutable offense. The Office of the Inspector General for the Department of Health and Human Services reported that fraud investigators had hit some major hurdles that “affected their ability to identify potential fraud and abuse.” Thus, while the practices in Houston raise eyebrows, nothing has been concretely identified as amounting to healthcare fraud. Still, the government should be keeping a watchful eye on the home healthcare industry in Houston, Texas.
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