For-Profit Home Health Care Companies Game Medicare Says Senate Committee

For-Profit Home Health Care Companies Targeted By Senate Finance Committee
The Senate Finance Committee recently released a report describing the Committee’s findings based on an investigation into Amedisys, LHC Group, Gentiva, and Almost Family, four of the largest publicly-traded home health care companies. The Committee says that home health care companies are gaking the Medicare reimbursement system for therapy visits to the homes of eligible Medicare beneficiaries.
Until January 2008, Medicare paid $2,200 for up to nine home therapy visits. When a tenth home therapy visit was made, Medicare would pay home health care providers an additional $2,200. According to CMS, prior to 2008, 10-13 visits were the most prevalent number of visits. The Committee’s report claims that Amedisys, LHC Group, and Gentiva “encouraged therapists to target the most profitable number of therapy visits, even when patient need alone may not have justified such patterns.”
The Committee’s Report alleges that during each 60-day period, home health agencies would receive “substantially higher payout[s]” for episodes in which the number of visits reached these new thresholds. The number of episodes near the old thresholds allegedly dropped approximately 28 percent while the number of episodes near the new thresholds increased by as much as 30 percent.
The Wall Street Journal published an article in April 2010 stating that Amedisys’ therapy visit reimbursement claims “cluster[ed]” around the ten visit threshold. In May 2010, the Senate Finance Committee requested documents from each company identified in the Wall Street Journal article. The Department of Justice issued a CID to Amedisys later that year. As we mentioned in our October 7, 2010 post, the issuance of a CID means that an investigation under the False Claims Act is in progress.
LHC Group entered into a settlement with the Government for $65 million, but did not admit any wrongdoing.
Until January 2008, Medicare paid $2,200 for up to nine home therapy visits. When a tenth home therapy visit was made, Medicare would pay home health care providers an additional $2,200. According to CMS, prior to 2008, 10-13 visits were the most prevalent number of visits. The Committee’s report claims that Amedisys, LHC Group, and Gentiva “encouraged therapists to target the most profitable number of therapy visits, even when patient need alone may not have justified such patterns.”