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Tribune looks at home health care businesses, finds lots of problems

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Illinois

A Tribune investigation reveals that Illinois public health regulators proved unprepared for a surge in new home health care companies, doling out too many home health licenses too fast and failing to provide meaningful oversight.

Even today, most anyone can own a home health care business for a $25 license fee — no criminal background check required.

Consequently, the Chicago metropolitan area is a hot spot for fraud, deemed among the most corrupt regions nationally. In the last five years, federal investigators estimate, area home-health agencies have improperly collected at least $104 million of public dollars. […]

An analysis of federal court and enforcement files since 2012 shows that thousands of patients have been subjected to unwarranted procedures, therapies and tests; some were prescribed unneeded and powerful drugs.

Most victims were unaware that their medical histories were hijacked by swindlers — there is no legal requirement to notify or warn patients when fraud is uncovered, or when providers are convicted of crimes.

* A big part of the problem here is lack of federal resources to investigate this stuff…

At least 357 active home health companies in the Chicago area have been linked to potential financial fraud by federal investigators but never charged, the Tribune found. […]

In 2014 congressional testimony, Gary Cantrell, a deputy inspector general for U.S. Department of Health and Human Services, acknowledged, “Since 2012, we have closed over 2,200 investigative complaints because of lack of resources.”

Go read the whole thing.

posted by Rich Miller
Thursday, Dec 14, 17 @ 11:18 am

Comments

Republicans
When you cut
Programs
Budgets
Agencies
Funds

This

Is what you get

This is what your
Profit worship
Gets you.

Corporations are amoral
By nature

Welcome to the world you have wrought

Comment by Honeybear Thursday, Dec 14, 17 @ 11:24 am
The great need for care is there
It is a huge wave
Looming overhead
Yet
Republicans
Will cut
And reroute funds
For robotics and automation
For private jets
For tax cuts for those not in need

Perfidy upon perfidy upon perfidy

Comment by Honeybear Thursday, Dec 14, 17 @ 11:28 am
Honeybear, I’m with ya - “starve the beast” is a catchy slogan and has the connotation that an admirable act is being applied to a bad thing (beasts are really bad things, right?) The catch phrase proves hollow when you consider the day-in, day-out work that is required because business owners are human; humans have greed; and some humans will exploit others ruthlessly if there’s no check on their greed. In this instance, “starving the beast” is a good thing if one understands that the beasts are the rip-off artists.

Comment by Johnny Tractor Thursday, Dec 14, 17 @ 11:53 am
DPH licenses the home health care companies. DPR licenses the medical employees working at the companies. Both agencies are run by Raunerites so it shouldn’t be a surprise to anyone that there are problems. Nobody seems to care that the residents in this state are put at risk daily. Somehow im sure it is Madigans fault.

Comment by Anon Thursday, Dec 14, 17 @ 12:06 pm
The $25 license fee is set in statute. Not so easy to fix as a simple rule change. Call your legislators.

Comment by Nick Name Thursday, Dec 14, 17 @ 12:15 pm
Lack of business regulation has untoward consequences, a reality that our libertarian friends don’t recognize. Now the public is paying in many ways for insufficient government oversight.

Comment by anon2 Thursday, Dec 14, 17 @ 12:29 pm
Home health fraud is a real problem, but the Tribune piece is off-base in suggesting that the low threshold for state licensure is to blame. In order to bill Medicare or Medicaid - where the real money and potential for fraud is - agencies have to be certified through federal CMS, not just licensed with the state. Medicare certification costs more, does require background checks and is a thorough process to the point of being onerous - plus, for the past year and a half, Illinois has been under a federal moratorium that disallows new home health agencies from being certified to bill Medicare or Medicaid. (The Chicago area has been under a moratorium for longer than that.) There are still loopholes; the moratorium doesn’t prevent an existing home health agency from changing hands, for example. And as extensive as federal Medicare regs are, some determined fraudsters still consider the profit worth all the trouble. But “lax” state licensure isn’t the problem here. In fact, becoming a home services agency or a home nursing agency (the licensed categories that tend to serve patients using private insurance rather than government programs) costs much more in Illinois. I think the $25 fee probably recognizes that federal barriers to billing Medicare are so great that piling another huge fee on top of them would only be burdensome and wouldn’t prevent fraud.

Honestly, this one is mostly on the feds. The majority of fraud is against Medicare (higher reimbursement rates than Medicaid and many private insurance plans), and that’s the federal government’s purview. The state could do a better job of educating the public about how to avoid fraudulent health care providers and what to do if they suspect fraud, but that’s about it.

Comment by Commander Norton Thursday, Dec 14, 17 @ 11:12 pm