By Clifford E. Barnes and Marshall E. Jackson, Jr.

Recent enforcements in home health fraud have highlighted the need for home health companies of every state to engage the State Medicaid payment agency in pro-active affirmative discussion to work together to identify issues related to fraud and abuse.  Such discussions will provide home health companies further insight regarding compliance with federal and state fraud and abuse laws. That being said, recent enforcement actions have shown that home health companies may be liable under fraud and abuse laws, despite efforts to comply with such laws.  

On September 9th Lewis J. Levine a chiropractor practicing in Washington, DC pleaded guilty to signing fake prescription for services to be provided by DC Medicaid in exchange for cash.  According to the plea agreement, Dr. Levine prepared prescriptions and approved and recertified plans of care for Medicaid beneficiaries brought to him by Personal Care Aids who worked for several home care agencies.  Dr. Levine was paid by beneficiaries and personal care aids $75 to $150 for each home health service he prescribed.  The home care agency was unaware of the payments to the Dr. Levine.  Under District of Columbia law, only physicians and advanced practice registered nurses can order home health services for Medicaid.  As a chiropractor, Dr. Levine was neither a physician or advanced practice registered nurse and cannot practice medicine.  In addition, Dr. Levine was not enrolled as a provider in DC Medicaid.  Nevertheless for more than 2 years Dr. Levine and company were able to execute a scheme against home health companies and the DC Medicaid Agency.  Even though Dr. Levine was not legally or medically qualified and could not determine whether the services prescribed were medically necessary, Dr. Levine signed intakes and plans of care.

For the home health companies whose services are denied and who did not participate in the scheme, it does not matter for the State Medicaid Agency that such companies were totally unaware of the scheme and could not reasonably know of such scheme.  For these non-participating companies, it is incumbent to not only remain diligent in efforts to comply with fraud and abuse laws, but to also develop a dialogue with the State Medicaid Agency to find ways in which they can work together to detect fraud and ensure that providers referring for home health services are legally and medically qualified to determine if such services are necessary. 

Is your home health agency involved in proactive discussions with your Medicaid policy office?