(October 9, 2010): The U.S. Attorney’s Office for the Southern District of Texas recently issued a Press Release announcing the conviction of a South Texas nurse who worked for a home health company. She allegedly admitted falsifying and forging encounter forms used when providing care for Medicare beneficiaries. This case is merely the latest example of South Texas home health fraud prosecuted by federal authorities. More specifically, the nurse reportedly falsified information such as:
". . .areas dealing with the beneficiary’s blood pressure, pulse rate, temperature, cardiac and respiratory status, homebound status and the medical supplies purportedly used during the visit."
As the government’s release further notes, the nurse also allegedly admitted to forging beneficiary signatures on the bottom of the forms. Sentencing is scheduled for next January. She reportedly faces up to five years in Federal prison and a criminal fine of up to $250,000.
I. South Texas Home Health Fraud Cases are Actively Prosecuted by Federal Authorities:
While few facts regarding how this conduct was uncovered have been disclosed by the government, home health companies in the Valley should take note of the fact that Medicare providers in South Texas (especially home health agencies, hospices and DME suppliers) remain under considerable scrutiny by ZPICs, OIG, the State MFCU, the FBI and DOJ. South Texas home health fraud cases have regularly been prosecuted by the U.S. Attorney's Office for the Southern District of Texas.
Under Health Care Reform’s mandatory compliance provisions, an effective Compliance Program will soon be required of all providers. While many home health companies already have Compliance Programs in place, the question to be asked is simple: Would instances of improper billing, such as those outlined above, be disclosed as part of your normal Compliance Program internal audit and monitoring process? If not, you have a problem.
II. Final Remarks:
We recommend that you review your current compliance policies and procedures to better ensure that problems can readily be identified and fixed. Having said that, take care when engaging consultants to review your agency or practice. To the extent that serious problems are identified, the information learned may not be privileged. As a result, should the government investigate your company, you may be forced to disclose negative reports and other findings that your consultants have issued -- essentially turning these internal audit documents into a "roadmap" for the prosecution. A better course is for you to work through your attorney. Have your attorney directly engage the consultant and supervise the review. That way, the report will be issued to your legal counsel. You may then at least arguably assert that any reports are privileged.
Robert W. Liles, J.D., grew up in South Texas and now serves as Managing Partner at Liles Parker, Attorneys & Counselors at Law. Liles Parker attorneys represent home health agencies, hospices and other Medicare providers throughout the country. Our staff has extensive experience responding to ZPIC audits and other health care fraud investigations. Call us at: 1 (800) 475-1906 for a free consultation.