DOJ alleges $10 million home health fraud scheme

A Texas home health agency owner is accused of fraudulently billing Medicare for more than $10 million, according to a release by the U.S. Department of Justice’s Southern District of Texas. Okorie Oko, 63, of Fresno, was arrested Thursday, April 28, 2022, and faces a five-count indictment, along with patient recruiter Henry C. Dobbins, 57, […]

CMS releases new HHVBP tools

CMS has provided a new video and guidance to get agencies ready for the national rollout of the Home Health Value-Based Purchasing model in 2023. The new tools include: The on-demand video Quality Measures Used in the Expanded HHVBP Model, providing measure-specific information on each of the quality measures included in the expanded Model. A […]

CMS updates documentation requirement for nurse practitioners

CMS is updating the requirements when an agency is working with a nurse practitioner for home health orders or the care plan. The new language, added to Chapter 7 §30.2.1 in the benefit policy manual, notes: “In the absence of State law governing collaboration, collaboration is to be evidenced by the NPs documenting their scope […]

Employee Fired for Excessive Absences After Making Need for FMLA Leave Known

The Family and Medical Leave Act (FMLA) prohibits an employer from interfering with an employee’s right to take medical leave. When pursuing such a claim, an employee need not allege the employer intended to deny the benefit, just that it was withheld. The employer’s motives are irrelevant when determining whether interference occurred. Of course, the […]

CMS updates nine-state HHVBP model’s results

CMS has released the fifth annual report of the Home Health Value-Based Purchasing Model as officials prepare to roll the nine-state model out nationwide beginning in 2023. The findings from the new report note Total Performance Scores were 7% higher among agencies in the HHVBP states: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee […]

Home health public reporting updated on Care Compare

CMS has updated the individual data for home health providers at Care Compare, the publicly reported data now includes two new measures. Visitors to the site will now see results for: “How often a patient’s functional abilities were assessed at admission and discharge and functional goals were included in their care plan (higher percentages are […]

Change request addresses technical issues with NOA, calculating gaps in service

A CMS change request issued April 7, 2022, is addressing issues identified with a unique issue with the transition to the Notice of Admission from the Request for Anticipated Payment, as well as a revision to make sure gaps in care are calculated consistently. The CR 12657 corrects the NOA process so that an NOA […]

CMS releases data on nursing home and hospital ownership

The Centers for Medicare & Medicaid Services (CMS) released public data on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare. The data includes the following: Changes of ownership have been much more common in nursing homes than hospitals over the past six years. There is also […]

CMS April 2022 OASIS quarterly Q&As

CMS provides further guidance surrounding when to complete RFA 7 (Transferred to an inpatient facility — patient discharged from agency) and when to complete RFA 8 (Death at home) in its second quarter OASIS Q&As, released April 19. The April Q&As include five questions covering additional topics such as: Further clarification regarding a patient’s ability to take their medications […]

CMS will pay for second COVID-19 booster for patients

CMS announced April 6, 2022, that it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna vaccines. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least four months ago are eligible for another booster to increase their protection against severe disease […]