Payment Suspended for 78 Agencies

By now, everyone has heard of the very busy Dr. Jacques Roy who had more home health care patients than anyone in the entire united states and is accused of causing greater than 345M in false claims to be billed to Medicare.

Have you read the actual indictment, though?  It names at least two RN’s as well.  That really doesn’t bother me because I don’t count nurses who pay homeless people money as colleagues.  I do so hope they lose their licenses.

What was tucked in at the bottom of the most recent article that came across my desk is that 78 home health care providers have apparently had their payments suspended pending the results of a full investigation.

This sounds extreme and it is because of the number of agencies that have payment suspended.  However, these are  not the first agencies who have had payment suspended because of ties to known or suspected physicians.

One client was assessed an overpayment of greater than 3M.  This is small time compared to the 345M that makes headlines.  Nevertheless, payment was suspended.  Another agency with the same medical director likewise had their payment suspended.  The second agency was not in a position to hire me due to the profoundly impaired cash flow.

Check your docs, folks.  After these agencies had funds suspended I began researching the docs for all ZPIC clients.  It is amazing what was found.  The problem is that the state board of medicine doesn’t actually report on issues while they are still under investigation.  In fact, the medical director referenced above was in jail for 8 months before the OIG added her to the exclusion list.  The state board of medicine still lists the license as active and having no disciplinary history.  (Jail doesn’t count, I suppose.)

I got the good stuff the way I get all the good stuff.  I googled the docs.  The press love photos of physicians being escorted out of buildings by men in uniforms.  If there are handcuffs involved, it makes the first page.

If a physician has a restricted license, be sure that you are fully aware of the restrictions.  Some physicians in recovery are not allowed to prescribe scheduled meds.  Often a nurse will write all meds a patient is taking including scheduled meds from another physician.  When the restricted doc signs the 485, he has just violated his license.  I had never come up against that before and frankly, I do not know how these will fare during review.  I am not hopeful, however.

For what it is worth, the client who was assessed the greater than 3M overpayment arranged to borrow the money from the bank so that Medicare could be paid back and the agency would be able to function until the appeals level of the audit.  Medicare said, ‘thanks but we are not restoring your payments until after the entire investigation is complete.

In other words, a year or longer.  That means that there are effectively 78 fewer agencies in Dallas this week.

On the bright side, you may get a really good deal on a licensed only agency but you will not be able to bill until you establish a new provider agreement with Medicare.  Remember, if you purchase a provider and assume their provider agreement, you have assumed their debt to Medicare.  You would think that would be obvious but it’s worth stating again.

So, check your docs.  If you find out any good stuff about docs in my area (Louisiana, TX, Fl, AL), send me a discreet email at julianne@haydelcs.com so I can ensure my clients are not unwittingly involved with someone who will get their cash suspended.