Category Archives: Home.Health

Hospital Chain Said to Scheme to Inflate Bills

Source: Julie Creswell, Reed Ableson, New York Times, January 23, 2014

Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors.

Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.

This month, the Justice Department said it had joined eight separate whistle-blower lawsuits against H.M.A. in six states. The lawsuits describe a wide-ranging strategy that is said to have relied on a mix of sophisticated software systems, financial incentives and threats in an attempt to inflate the company’s payments from Medicare and Medicaid by admitting patients like an infant whose temperature was a normal 98.7 degrees for a “fever.” …

….For H.M.A., the timing could not be worse. Shareholders recently approved the planned $7.6 billion acquisition of the company by Community Health Systems, which will create the nation’s second-largest for-profit hospital chain by revenue, with more than 200 facilities. The deal is expected to be completed by the end of the month. ….

…When Jacqueline Meyer, a regional administrator for EmCare, a company that provided emergency room physicians to a number of H.M.A. hospitals, refused to follow H.M.A.’s directives and fire doctors who admitted fewer patients than H.M.A. wanted, she was fired, according to the lawsuit she filed with Mr. Cowling. The Justice Department has not yet decided whether to join her lawsuit against EmCare, which declined to comment….

Faulty Websites Confront Needy in Search of Aid

Source: Frances Robles, New York Times, January 7, 2014

Three months after the disastrous rollout of a new $63 million website for unemployment claims, Florida is hiring hundreds of employees to deal with technical problems that left tens of thousands of people without their checks while penalties mount against the vendor who set up the site.

Efforts at modernizing the systems for unemployment compensation in California, Massachusetts and Nevada have also largely backfired in recent months, causing enormous cost overruns and delays.

While the nation’s attention was focused on the troubled rollout of the federal health care site under the Affordable Care Act, the problems with the unemployment sites have pointed to something much broader: how a lack of funding in many states and a shortage of information technology specialists in public service jobs routinely lead to higher costs, botched systems and infuriating technical problems that fall hardest on the poor, the jobless and the neediest.

As a result, the old stereotype of applicants standing in long lines to speak to surly civil servants at government unemployment offices is quickly being replaced. Now those seeking work or government assistance are often spending countless hours in front of buggy websites, then getting a busy signal when they try to get through by phone. …

…Deloitte defended its work, saying that most jobless people have been able to file for benefits without trouble. It blamed the department for the latest setbacks because, the company said, it changed requirements that strained Deloitte’s resources. The company has already made more than 1,000 fixes and successfully processed at least 300,000 claims, Deloitte said in response to the latest fine.

Deloitte said a 2012 report by the Government Accountability Office showed that states were struggling to modernize their unemployment insurance programs, because governments lacked the budgets and the trained staff to make the updated systems work. Most of the issues that continue to dog the project, the company said, are beyond its control or have nothing to do with the software. …

Audit: DPW payroll glitches cost taxpayers millions

Source: Amy Worden, Philadelphia Inquirer, November 14, 2013

The botched rollout of the Department of Public Welfare’s effort to consolidate payroll services for home health-care workers for the disabled led to thousands of those employees going unpaid for as long as four months this year and cost taxpayers millions in extra care costs, according to a new audit.

The report, released Thursday by state Auditor General Eugene DePasquale, examined a December 2012 decision by then-DPW Secretary Gary Alexander to cancel 36 state-based contracts for payroll services to those workers who provide long-term care for the disabled and award a single contract to Boston-based Public Partnerships Ltd.
Related:
Audit criticizes delays in payments for Pennsylvania caregivers
Source: Kate Giammarise, Pittsburgh Post-Gazette, November 14, 2013

Years of poor oversight by the Department of Public Welfare, followed by a botched transition into a new payroll system for workers caring for the elderly and disabled, caused thousands of those caregivers to go without paychecks for months and harmed the well-being of the state’s most vulnerable residents, according to a state audit released Thursday.

Performance Audit: Department of Public Welfare’s Oversight of Financial Management Services Providers

Source: Commonwealth of Pennsylvania, Department of the Auditor General, November 2013
Summary
Press Release

Inside the hidden world of thefts, scams and phantom purchases at the nation’s nonprofits

Source: Joe Stephens, Mary Pat Flaherty, Washington Post, October 26, 2013

…A Washington Post analysis of filings from 2008 to 2012 found that Legacy is one of more than 1,000 nonprofit organizations that checked the box indicating that they had discovered a “significant diversion” of assets, disclosing losses attributed to theft, investment fraud, embezzlement and other unauthorized uses of funds. The diversions drained hundreds of millions of dollars from institutions that are underwritten by public donations and government funds. Just 10 of the largest disclosures identified by The Post cited combined losses to nonprofit groups and their affiliates that potentially totaled more than a half-billion dollars. … As part of its analysis, The Post assembled the first public, searchable database of nonprofits that have disclosed diversions. …

County sets date for CHHA hearing

Source: Ben Beagle, Livingston County News, July 25, 2013

The County Board of Supervisors will conduct a public hearing at its Aug. 14 meeting to get public input on a possible sale of its certified home healthcare agency. The public meeting will follow two Board of Supervisors’ committee meetings in which a recommendation could be made on the sale of the agency’s operating certificate. Two agencies, which have not been publicly identified, responded to the county’s request for proposals to take over the license of the county’s home healthcare agency, or CHHA (“cha”)….

…In April, Coyle said that the CHHA has been operating at a deficit and officials were concerned about increasing competition after two — and then a third — private agency submitted certificates of need with the state Department of Health to start a certified home health agency in the county. Representatives of the Civil Service Employees Association, the union that represents CHHA employees, have disputed county concerns about the CHHA’s finances. The union has also expressed concern about what would happen to clients who are indigent or have a low reimbursement rate should a private agency take over. Livingston County’s CHHA provided about 20,000 total visits to county residents in 2012….

State Rewards Home Care Firms Once Rebuked

Source: Nina Bernstein, New York Times, June 23, 2013

Hunting for ways that the incoming governor could close a $2 billion budget deficit late in 2010, New York State officials scrutinized Medicaid spending on home health care, and made some startling discoveries. The cost of caring for frail elderly and disabled people at home had more than doubled from 2003 to 2010, to $1.3 billion, even though fewer people were being served. And that huge cost increase had been driven by just a half-dozen certified home health agencies out of 140, most located in Brooklyn. Two names stood out: Excellent Home Care and Extended Home Care. During a broad investigation of Medicaid fraud he conducted as attorney general, Gov. Andrew M. Cuomo had showcased his role in reclaiming $3.7 million from Excellent and $9.5 million from Extended in a settlement of false-claims suits against them. The agencies admitted no wrongdoing. Now a transformation of the state’s long-term care system is in high gear, as the state has extended invitations to agencies to be a part of the new system. Among those chosen: Excellent and Extended.

Six hundred jobs to be eliminated as home health waiver jobs are outsourced to private companies

Source: Kim Chandler, AL.com blog, May 30, 2013

About 600 home health workers with the Alabama Department of Public Health will lose their jobs at the end of the fiscal year when those positions will be moved to the private sector. The jobs are being eliminated because the Health Department will cease being a service provider for the state’s Elderly and Disabled Medicaid Waiver. The program aims to keep people out of nursing homes by providing services such as assistance in bathing and housekeeping to help them live at home. However, beginning Oct. 1, the Health Department will stop providing the services for the Department of Senior Services after the Alabama Legislature did not give the Health Department requested matching funds. Legislators instead gave the Department of Senior Services, which manages the waiver program, a $2 million funding increase to provide the services through contracts with private providers. …The Elderly and Disabled Medicaid Waiver Program had been previously managed by both the Alabama Department of Senior Services and the Alabama Department of Public Health. Senior Services recently took over sole management of the waiver program….

Budget push for more privatization skirts full disclosure

Source: Michael Van Sickler, Tampa Bay Times, April 26, 2013

Budget language that would ask the state to develop a plan to move those with developmental disabilities through a managed care system has drawn fire from some non-profits, who say it was inserted at the last minute without public discussion…. The new language would require the Agency for Health Care Administration and the Agency for Persons with Disabilities to develop a plan for serving Medicaid patients with developmental disabilities in a comprehensive managed care program. The program must be mandatory for all eligible recipients, competitively bid, and operated by comprehensive long-term care provider service networks for people with developmental disabilities…

Day Centers Sprout Up, Luring Fit Elders and Costing Medicaid

Source: Nina Bernstein, New York Times, April 22, 2013

…In Bensonhurst, Brooklyn, at the new R & G Social Adult Day Care Center, known locally among elderly immigrants for luring clients with cash and grocery vouchers, most people there for lunch did not stay to eat. Instead, many walked briskly toward the subway carrying bags stuffed with takeout containers, and two elderly men rode away on bicycles with the free food.

Not a wheelchair or walker was in sight at these so-called social adult day care centers. Yet the cost of attendance was indirectly being paid by Medicaid, under Gov. Andrew M. Cuomo’s sweeping redesign of $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities. Such centers have mushroomed, from storefronts and basements to a new development in the Bronx that recently figured in a corruption scandal. With little regulation and less oversight, they grew in two years from eight tiny programs for people with dementia to at least 192 businesses across the city….

… Managed care became mandatory last year for people receiving home services who are eligible for both Medicaid and Medicare. The idea is to try to control spending, but about a third of the 92,000 people so far enrolled in the system statewide are newcomers to such services, many responding to aggressive marketing by social day care centers.

Centers collected over $25 million from managed care plans in the first nine months of 2012, at roughly $93 per person per session, according to state figures. The managed care companies are paid by Medicaid; in New York City, the rate is about $3,800 a month per member. …

…Beneficiaries are supposed to be impaired enough to need at least 120 days of help with tasks like walking, bathing or taking medication. But managed care companies, not government agencies, are now mainly in charge of determining eligibility, typically by using nurses to assess each potential member….

WFSE/AFSCME Council 28 Privatization Battles

Source: Jeanine Livingston, Washington Federation of State Employees, March 12, 2013

AFSCME Council 28 has invested additional resources into fighting privatization since the passage of the Civil Service Reform Act of 2002.

In the Civil Service Reform Act of 2002, contracting-out of state work that was previously prohibited was made permissible under certain circumstances:
– it must result in a savings or efficiency improvement; and
– affected employees must have an opportunity to present alternatives.

Since the effective date in July 2005 our biggest fight has been getting the state to honor the obligation to bargain the decision to contract and to apply the competitive contracting law that allows employees to present alternatives.

We’ve had some successes in fighting of major efforts to privatize but have seen some contracting-out in individual, low-impact circumstances.

Successful campaign strategies include:…

Examples of Recent Contracting Out Campaigns:
Child Welfare Privatization, 2009 – 2013…
Closing Juvenile Rehabilitation institutions to move to community-based care, 2009…
Privatize Disability Lifeline/GAU, 2009…
DD Client care movement to community-based care, ongoing/constant…
IT consolidation and contracting, 2011…
Consolidation of state’s support services, 2011…
Parks: Fort Worden, 2007-present…
Labor and Industries: initiatives to privatize workers compensation, 2010 – present…
Statewide: Construction Trades, ongoing…