Government Investigation of Amedisys

[sweetsugar]

If there are any nurses (or therapists) out there who have any personal knowledge about how the frequencies are determined by the physical and occupational therapies for Amedisys' Balanced for Life Program, the House Senate and Finance Committee is very interested in what you have to say. You may fax your responses to:

The Honorable Max Baucus

Committee on Finance

United States Senate

219 Dirksen Senate Office Building

Washington, D.C. 20510

The Honorable Chuck Grassley

Committee on Finance

United States Senate

219 Dirksen Senate Office Building

Washington, D.C. 20510

FAX: [phone].

They are very interested in what clinicians have to report about the Balanced for Life Program (e.g., how do the therapists determine how many visits the patient requires).

Believe me, they will get in touch with you if you have something pertinent to add to the ongoing investigation that is being conducted on over-utilization of therapy visits by the various companies under investigation.

Nurses - speak up!!

[happytherapist]

I worked for LHC during the years when 10 therapy visits was the magic number and yes they told us to get 10 visits and did not want us to get less or more than 10. Yes it was known by manages and many Therapist in many of the branches were asked to do the same. It was not an isolated thing. OIG knew and still did nothing about it. Took the Wall Street Journal to put numbers together and do OIG's job. This was just one of many many unethical behaviors they were involved in.

[Pfiesty]

Does anyone know any outcomes regarding the efficacy of the balance programs? I was told by some of these companies about the specific treatment modalities and the goal of improving balance and reducing falls. If these programs are improving balance, maintaining independence, and avoiding all the costs related to falls: surgery and complications, durable medical equipment, increased SNF and home health costs, then what is the problem? If the goals have been achieved and the outcomes are realized, then why are the feds being penny wise and lb foolish? Or is the whole program a scam? I don't know. Does anyone have any statistics?

[Willow Moonsidhe]

What you should be investigating is the labor practices. The patients never get enough visits.

[pandora25081]

Home health agencies such as LHC,Amedysis, Gentiva, etc. do game the system and commit medicare fraud. that is why they have so many recerts and needless admissions. This is part of the reason Medicare might not be available in the future d/t fraud from health care co.. If people didn't stir "trouble" nobody would be caught committing fraud!!

[paddler]

Does anyone know any outcomes regarding the efficacy of the balance programs? I was told by some of these companies about the specific treatment modalities and the goal of improving balance and reducing falls. If these programs are improving balance, maintaining independence, and avoiding all the costs related to falls: surgery and complications, durable medical equipment, increased SNF and home health costs, then what is the problem? If the goals have been achieved and the outcomes are realized, then why are the feds being penny wise and lb foolish? Or is the whole program a scam? I don't know. Does anyone have any statistics?

The OASIS set is gathered to provide this information. You can see the results for individual companies here:

http://www.medicare.gov/HomeHealthCompare/search.aspx

[KateRN1]

The government did this to themselves. When they pay an agency the same rate for 7 therapy visits as for 8 therapy visits (or 9 or 10), then they will automatically see "free visit" for visits 8-9. It's the nature of the beast.

While I think the idea of Home Health Compare is a good one, the data is only as good as those who are collecting it. Few home health agencies, in my experience, do a good job at training their clinicians in the collection of OASIS data. This skews all the data and makes comparison nearly impossible. I think that the data on Home Health Compare is more useful in determining how well agencies are orienting their clinicians than to making apples to apples comparisons.

As for the balance program at Amedisys--I am by no means a fan, but the PTs that I worked with who were trained in that program used it with awesome results. But that was one agency, no idea about other places and how it was used there. I think part of the investigation centered on using PTs to do wound care visits, which increased therapy utilization and in turn increased reimbursement.

I would dearly love to see Medicare do away with the PPS model, relax some of the stupidest rules and regs, and allow us to operate as primary care providers, billing as we go. I dream big these days.

[berube]

an;yone know how much the fine is for these agencies,,,,gentiva just announced "cutbacks", can't help but think it has to do with this fine.

[Isabelle49]

i'll have to text my friend who is with Gentiva and get the scoop.

[KateRN1]

$12.5 Million. A pretty penny.

http://www.justice.gov/usao/nye/pr/2011/2011jun01.html

[tnnrse11]

If I could get to the SFC I would give them an ear full of everything I have seen in my area.

Amedisys violates every part of the Stark Law, Hippa laws, you name it.

Having worked for Gentiva they are 100% Therapy driven. They have 3 times the therapist than they do nurses, my "Branch Director" was a PT and made no bones about it that Therapy paid the highest reimbursement. If nurses and therapy disagreed on Oasis Data the nurse ALWAYS yielded to the Therpaist opinion. Big suprise therapy always placed the pt higher on the Oasis Data collection, therefore creating additional reimbursement.

Locally the Gentiva branch is using a non qualified nurse to do their Psych RN visits. Less than 1 year prn experience in psych. It angers me because those patients are receiving absolutely no help whatsoever!!!

Think about this....actually eleminating the fraud may increase Home Health Salaries instead of decreasing them. Qualified staff, making qualified reimbursable visits. When CMS goes to Pay for performance in 2012 you will see a lot of companies go under.

Also, Gentiva has several class action lawsuits against them because their RN's have to do the Oasis SOC even if NO SNV is ordered, than they send a Therapist out to do a "Secondary eval." even if SN does not pick the pt up for skill the nurse is the Case Manager and ALL THIER STAFF spend hours upon end at night and weekends trying to get paperwork completed, UNPAID.

[sweetsugar]

I did not realize that Gentiva had been fined for fraud. LHC in Louisiana received a $65 million fine in September 2011 for fraud. Both of these fines do not have anything to do with the October 3, 2011, report from the House and Senate Finance Committee investigation findings. That proceeding is now in the hands of the U.S. Dept of Justice. It will be very interesting to see just how large of a fine each of these companies (Gentiva, LHC, and Amedisys) has to cough up. I would even venture to say that some people from Amedisys are possibly going to be going to jail over their actions. If you would like to see some interesting stuff, just Google October 3, 2011, +House +Senate +Finance +Medicare +Home Health. I was amazed to see just how far some companies have gone to "game" Medicare.

[sweetsugar]

Actually, just Google the following: Staff Report on Home Health and the Medicare Threshold. That will bring up the October 3, 2011, House & Senate Finance Committee's full report. Very interesting reading.