Government Investigation of Amedisys

tabster224 · Jul 24, 2010

My question to you is why do you just mention Amedisys? There are other companies involved in this "investigation". " Senate Finance Committee had launched an investigation into the practices of Amedisys Inc., Gentiva Health Services Inc., LHC Group Inc., and Almost Family Inc."

If you are going to mention one you should have mentioned the other three also. Could be a disgruntled employee? I have worked for 2 of those 4 companies and I can tell you from experience, at the branches I worked for (and between the 2 companies, I have worked for 4 different branches), there is nothing to the investigation. Stop trying to stir up trouble.

ArwenEvenstar · Jul 25, 2010

My question to you is why do you just mention Amedisys? There are other companies involved in this "investigation". " Senate Finance Committee had launched an investigation into the practices of Amedisys Inc., Gentiva Health Services Inc., LHC Group Inc., and Almost Family Inc."
If you are going to mention one you should have mentioned the other three also. Could be a disgruntled employee? I have worked for 2 of those 4 companies and I can tell you from experience, at the branches I worked for (and between the 2 companies, I have worked for 4 different branches), there is nothing to the investigation. Stop trying to stir up trouble.

Just speaking generally here...As I actually know nothing at all about Amedisys or the other mentioned companies. But I did not perceive the original post as stiring up trouble. There is nothing wrong with getting the word out there. It is a Senate level investigation. If there is nothing to it, as you say, then the official investigation should reveal that. You say "there is nothing to the investigation". But how do you know? I hardly think you knew everyone and everything going on....cover-up can go deep and be found in surprising places.

People often have to be encouraged to speak up when there are unethical or inappropriate things going on with a company. It takes a lot of courage. It can be very hard to be a whistle blower or otherwise speak up about legitimate problems. It is stressful. Whistle blowers are often mis-understood. Etc. It is easier to say nothing, turn a blind eye, and/or just resign.

I spoke up about some serious issues at a company I once worked at...The one supervisor thanked me for being willing to speak up. She said most others just quietly resigned, instead of speaking up, and thus the problems continued.....Sad. But I can understand why people quietly resign...I went through a great deal of stress. Some people (like this supervisor) supported me, but I was unfairly maligned by others.

So, I always try to be supportive of people willing to speak up...

tabster224 · Jul 25, 2010

What I meant to say, and I do apologize, I was in a hurry when I wrote that reply, is that all I can speak for are the branches I worked for at the time I worked there. You are right, I don't know about every branch for both companies I worked with. One of the companies I worked for I would never work for again, but they did nothing wrong at the branches where I worked. I am a nurse and we work closely with the PT's so, the branches I worked with at the time I was there, were doing nothing wrong.

My original point was that she should have mentioned all the companies and not just Amedisys. To me, only mentioning the one company makes it sound like she's got an axe to grind with that company otherwise she would have mentioned all 4 companies. I could be totally off base, just my observation.

I too support people speaking up if something is going on that shouldn't be, but to just mention one company and one program when more are involved, isn't right.

sweetsugar · Jul 25, 2010

With respect to why I only mentioned Amedisys' Balanced for Life program -- I only have knowledge of this particular program. I only worked for Amedisys. The investigation surrounds overutilization of therapy in home health. If you -- or other nurses/therapists are aware of the other agencies having similar programs, the Senate Finance Committee would also welcome comments on their programs, as well.

And, yes, I am very disgruntled -- I am a disgruntled American. I have seen so much fraud and abuse in home health care the past couple of years that I -- as a citizen want something done about it. Apparently, MedPac and CMS agree. Check out the proposed home health care changes that were posted in the Federal Register on July 23, 2010 (Friday). Throughout the proposed changes, the words fraud and abuse are mentioned repeatedly.

Just so you all know -- as nurses in home health -- once these changes go into affect, there are drastic changes coming in 2011. It's about time. The proposed changes implement a $900 million reduction to home health reimbursements beginning in 2011. There are many more changes that indicate that the government has caught on to the fraud in home health and is going to clamp down on it.

So yes -- I am disgruntled -- AND HOPEFUL. :yeah:

caliotter3 · Jul 25, 2010

Too bad that the federal government move to cut down on reimbursement will result in less employment opportunities for providers who only do authorized care. Where I live, home health employers use "decreases" in reimbursement, real or imagined, as an excuse to lower pay and provide less work; a common practice. This has been going on for years and is accepted.

Isabelle49 · Oct 10, 2010

I am looking forward to seeing Amedisys as the feature on American Greed.

BTW, how many of you work for agencies who have begun uitilizing Physical Therapists to perform wound care, even if the patient has no Physical Therapy ordered or needed? Did you know that PT performing wound care only is billed as a PT visit. I haven't looked this up in the Medicare CoP's, but have always wondered how they get away with it. In the past nurses did all wound care, Medicare added bonus for PT visits and suddenly PT is doing wound care - I would think this is obvious - a 5 year old could figure that out.

GoNightingale, BSN, RN · Oct 10, 2010

I am looking forward to seeing Amedisys as the feature on American Greed.
BTW, how many of you work for agencies who have begun uitilizing Physical Therapists to perform wound care, even if the patient has no Physical Therapy ordered or needed? Did you know that PT performing wound care only is billed as a PT visit. I haven't looked this up in the Medicare CoP's, but have always wondered how they get away with it. In the past nurses did all wound care, Medicare added bonus for PT visits and suddenly PT is doing wound care - I would think this is obvious - a 5 year old could figure that out.

I am just starting to work for a Home Health Care agency (non of which were mentioned above) as a well....I don't even know the name of my function as an RN. I know that I will be going to the patient's home to do the initial assessment and paper work to see if they qualify for home health visits and if so "frequency and duration". I am using the OASIS forms for the Medicare recepients and for those with private insurance (still training for those forms). But I guess I have alot of questions to all that have posted regarding these companies under investigation. Am I what's considered a case manager? Could someone tell me how to ethically determine the frequency and duration of RN visits. The person that briefly started to train me infomred me that after a patient is discharged from SNF and have a physician's order for home health care, the duration of the visits that are Medicare Certified is 60 days.Could someone suggest resources where I could become well informed about this new function I'm taking on, as well as the ethics, legalities, Medicare, Medicaid, private insurance etc.I feel at this point that I need to be better informed.

Thanks everyone for all of your great input. :yeah:

Isabelle49 · Oct 11, 2010

I am just starting to work for a Home Health Care agency (non of which were mentioned above) as a well....I don't even know the name of my function as an RN. I know that I will be going to the patient's home to do the initial assessment and paper work to see if they qualify for home health visits and if so "frequency and duration". I am using the OASIS forms for the Medicare recepients and for those with private insurance (still training for those forms). But I guess I have alot of questions to all that have posted regarding these companies under investigation. Am I what's considered a case manager? Could someone tell me how to ethically determine the frequency and duration of RN visits. The person that briefly started to train me infomred me that after a patient is discharged from SNF and have a physician's order for home health care, the duration of the visits that are Medicare Certified is 60 days.Could someone suggest resources where I could become well informed about this new function I'm taking on, as well as the ethics, legalities, Medicare, Medicaid, private insurance etc.I feel at this point that I need to be better informed.
Thanks everyone for all of your great input.

I am hoping you are being provided with an adequate orientation, though I wouldn't be surprised if your were not. That is the usual.

I have been a Home Health Nurse for 8 years now, and I see patients in their homes. I am called a Field Nurse. Some companies will inflate the name of the position to Case Manager, though there will be no additional monies attached to the title.

Frequencies: You will have to consider the patient's condition, diagnoses and medications to determine the frequency of visits that will have to be made to assess and teach meds, disease, diet, safety. A patient needing wound care would probably need more visits than a patient with HTN and DM or other problems. A patient newly released from the hospital may require 2 - 3 visits by a nurse the first week, then weekly if stable, but the increased frequency can be extended as long as it is necessary and reasonable.

As a home health nurse, YOUR biggest job will be to be a Patient Advocate. There will be times where you will have to convince administration that a patient needs more care - just be sure you've documented all the details as to why you feel this is necessary.

I hope this is helpful. Remember,you biggest job will be as Patient Advocate - if you can handle that, you can handle anything in home health.

Isabelle

GoNightingale, BSN, RN · Oct 11, 2010

I am hoping you are being provided with an adequate orientation, though I wouldn't be surprised if your were not. That is the usual.
I have been a Home Health Nurse for 8 years now, and I see patients in their homes. I am called a Field Nurse. Some companies will inflate the name of the position to Case Manager, though there will be no additional monies attached to the title.
Frequencies: You will have to consider the patient's condition, diagnoses and medications to determine the frequency of visits that will have to be made to assess and teach meds, disease, diet, safety. A patient needing wound care would probably need more visits than a patient with HTN and DM or other problems. A patient newly released from the hospital may require 2 - 3 visits by a nurse the first week, then weekly if stable, but the increased frequency can be extended as long as it is necessary and reasonable.
As a home health nurse, YOUR biggest job will be to be a Patient Advocate. There will be times where you will have to convince administration that a patient needs more care - just be sure you've documented all the details as to why you feel this is necessary.
I hope this is helpful. Remember,you biggest job will be as Patient Advocate - if you can handle that, you can handle anything in home health.
Isabelle

Thank you so much for your words of Wisdom regarding EVERYTHING! I have not yet been scheduled for training, but have begun reviewing the OASIS-C from for SOC and ROC. I would like to become more knowledgeable in the criteria that Medicare uses in the assessment made by the clinician in order to deny or approve a payment. I've read that they the DRG's but I'm interested in how they review our assessment and what the type of language I would need to use to advocate for a patient if they needed more treatments. Any ideas or resources that you or anyone out there know of?

Thank you Isabelle! Kudos from me! :yeah:

Luv2care0907 · Oct 20, 2010

When you start legislating medical care, you ruin good medical care for everyone. I happen to love my job or I wouldn't take the abusive wage cut I had to take to keep my job thanks to the bureaucracy of Medicaid claiming fraud. I was reduced to an LPN because supposedly an LPN can handle a frail preemie fresh out of the hospital weighing 4 lb. 12 oz on O2 and several meds. So please do not lecture us on "fraud." It is a way of reducing the cost of medicine by cutting our wages to usher in socialized medicine. There is simply not enough money for government to take on that responsibility. They can't afford to pay nurses $30/hour. So who is going to be the scapegoats? Nurses and therapists. All you nurses that think you're helping this person are in for a big surprise when you get your first paycheck under that plan. What they will do with this information is claim that everyone is misleading the government because of a few people that scammed the system. These people are not reflective of the rest of us who take our jobs seriously and help people heal. I work hard for my money and I do an excellent job for people. My experience and knowledge have helped these people on several occasions. That's what I'm here for and I grossly resent it when someone like you comes in pretending to be a do-gooder when in actuality, you are looking for ammunition to cut our wages. . . again. :yawn:

laughing weasel · Oct 20, 2010

I am in home health. There is no provision in reimbursement for OT. yet the patients need coverage so there has to be some flexibility in the system. A lot of money is saved by having patients cared for in their own homes. If there is fraud it should be punished. I will not accept a reduction in pay I will find other work should it be necessary. If enough people do this wages will go back up as more money is spent on hospitalizations that are unnecessary due to lack of skilled care givers.