The Medicaid Fraud Control Unit (MFCU) of the New York State Attorney General’s office reached a $24 million settlement with three home health care agencies that allegedly billed Medicaid for services provided by hundreds of home health aides who lacked proper training credentials.
Certified Home Health Agencies (CHHA) are responsible for making sure that home care aides meet training and qualification requirements for Medicare and Medicaid when they bill the government for home health aide services. Many of the New York aides received their certificates from fraudulent training programs that provided little or no training.
Extended Home Care and Excellent Home Care Services, the two CHHAs involved in the settlement, had contracts with Nursing Personnel Home Care, a Licensed Home Care Services agency (LHCSA), to provide home health aide services.
Proper Protocol Violated
Under NY law, LHCSAs cannot bill Medicaid directly but can supply home health aides to CHHAs. The LHCSA should have checked the employees’ statuses, kept personnel files on each employee, and shared the files with the CHHAs, according to the settlement.
To become certified in New York State, home health aides are required to have 75 hours of training at a program licensed by the state’s Department of Health or Education Department.
Whistleblowers Expose Fraud
The Medicaid fraud came to light when two whistleblowers filed complaints in 2006 and 2007 under the federal “False Claims Act” and state laws; each will receive a percentage of the settlement. The federal government will receive $9.7 million and New York State will receive $14.3 million.
New York Attorney General Andrew Cuomo’s office filed the suit in May 2008 as part of a three-year investigation of New York home health care agencies. The settlement was reached in late December 2009. Two of the schools involved in the fraud pleaded guilty to grand larceny in 2007.
Preventing Future Fraud Cases
The New York State Department of Health’s website hosts a list (pdf) to help employers verify whether a provider training program is licensed by the state; the state Education Department licenses proprietary school training programs (pdf).
“The state has taken steps to provide employers and the public with better information about the training of home care aides. There needs to be additional examination of the quality of the training program,” said PHI New York State Policy Director Carol Rodat.
“Given the needs of today’s home care population, 75 hours is less than is needed to handle the complexity of the clients,” Rodat said.
– by Deane Beebe
I work Home Health for our county, I will have to say that in order to work You 1st need CNA certificate, then we provide the training that they need to go into our homes. 15 years ago when I first worked for Home Health we needed our CNA certificate then we went to the local college for more training, it was about 75 hrs. on top of what we had. We need to train and educate these people that are taking care of our loved ones. I think every state needs to treat Home Health as they do any other agency. Home Health is definately another alternative for our aging population and we need to handle this seriously it is growing fast!!
The state I am working and from is Iowa.
A story like this is not all that suprising.
Credentialing has come a long way with the creation of Joint Commission Standards and increased attention to the importance of credentialing in healthcare. And, medical staff professionals are a dedicated well meaning group who have really evolved their profession.
However, there are two fundemental trends that continue to allow repeated failures in the credentialing process.
1. The C-Suite does not tend to view credentialling as a strategic function/process in healthcare delivery. As the old saying goes, “organizations do well what the boss checks.” The lack of executive oversight into the process of credentialing leaves the process exposed to problems.
2. There is a lack of automation in the process which would create the needed safeguards. Or, more accurately, automation is seldom used to manage the credentialing process. Automation creates structure and sanity in a very complex process. Again, the fact that the C-suite is not engaged in credentialing means funding is difficult to secure for credentialing automation.
John Eddy
IntelliSoft Group