Yesterday, the cover of the Wall Street Journal read “Home Care Yields Medicare Bounty.” Writer Barbara Martinez took an in-depth look at the home care industry, particularly the physical therapy industry, and specifically, home health giant Amedisys, Inc. The premise of the article seems to be that industry leaders are gaming the Medicare system. According to Martinez:
“[A]n analysis by The Wall Street Journal of Medicare payments to home health-care companies in recent years raises questions about whether some companies — including the sector’s largest, Amedisys Inc. — are taking advantage of the Medicare reimbursement system.”
The WSJ noted that home therapy has increased 74% and occupational therapy has increased 51% over a recent ten-year period while home health in all other sectors — skilled nursing, medical social work, etc. –has declined. Amedisys, notes Martinez, has “skyrocket[ed” from a company founded in 1982 by entrepreneur William Borne on a loan of $1,500 to a $88 million a year company in 2000 to a $1.5 billion annual revenue company last year. In the last decade, its stock has soared from $1 per share to $60 per share. The only thing more staggering than those numbers is this fact noted by WSJ: “Amedisys derives 90% of its revenue from Medicare reimbursements” (i.e. the taxpayers). Some interviewed in the WSJ article question the legitimacy of what appears to be an “industry-wide” pattern of profiteering from the Medicare system. Martinez writes that MedPac commissioner, Arnold Milstein, “questioned whether all the home visits were appropriate.” He is quoted in the article as saying:
“Looking at the great speed with which the volume of services adapts to payment changes, which are breathtaking, it does suggest that there may be a problem with certifying the appropriateness of these services.”
WSJ hired Yale professor Henry Dove to analyze Medicare data who found a pattern of “clustering visits at reimbursement trigger points.” One former Amedisys nurse agreed and cited her own anecdotes:
“‘I was told ‘we have to have ten visits to get paid,’ says Tracy Trusler, a former Amedisys nurse for two years in Tennessee, who left the company. Her supervisors, she says, asked her to look through patients’ files to find those who were just shy of the 10-visit mark and call their assigned therapists to remind them to make the extra appointment. ‘The tenth visit was not always medically neccesary,’ Ms. Trusler says.”
To report physical therapy fraud, home health fraud, or Medicare fraud contact Frohsin & Barger.
[…] Posts Wall Street Journal Says Amedisys And Other Home Health Companies May Be "Taking Advantage" of Medic…DoJ Announces Fraud Indictment Over EPA Superfund SitesDyncorp Employee Pleas Guilty to Killing […]
[…] care leader Amedisys, Inc. and three other home health care companies expressing concern about a recent Wall Street Journal article indicating that the companies may be gaming the Medicare system. The other companies were Almost […]
[…] of the Senate Finance Committee inquiry and Securities and Exchange Commission investigation.” In late April the Wall Street Journal published an article questioning whether Amedisys had committed Medicare fraud. Shortly thereafter, the Senate finance […]
The Amedisys nurse quoted is correct. In Atlatna, not only did I hear the same instructions, but they also implement the “Balance Track” treatment regimen, which may or may not be appropriate for each client, under the guise of “market research” of their program. My question at the time was whether their research should be done on paying customers who might benefit more from other treatment regimens.
They did not appreciate my questions and I was told that the instructions came from corporate positions. Other of my co-workers had similar questions and grumblings, but did not speak up for fear of losing their jobs. I felt it was pushing the ethical lines. I no longer work there as a licensed Physical Therapy Assistant.
[…] Wall Street Journal Says Amedisys And Other Home Health Companies May Be “Taking AdvantageR… April 2010 4 comments 3 […]
[…] #1 Wall Street Journal Says Amedisys And Other Home Health Companies May Be “Taking AdvantageR… […]
[…] Billing for medically unnecessary physical therapy services is a growing fraud that strains the country’s healthcare system. Last week, Aleksandr Kharkover, a New York physical therapist recently pleaded guilty to causing almost $12 million in false claims to Medicare and Medicaid for unnecessary or non-existent physical therapy services. He has not yet been sentenced, but faces 50 years in prison for his crime. While $12 million may seem like a lot, it is a mere drop in the bucket compared to the revenue of the mega home health physical therapy providers like Amedisys who bill Medicare in excess of a billion annually and have recently come under scrutiny for alleged unnecessary services. […]
[…] announced their suspicion of the sector’s billing practices. Fraudblawg has reported on media exposure of the questionable conduct, as well as inquiries by the Senate Finance Committee, the SEC, and the […]
I get pleasure from, cause I discovered just what I was looking for.
You have ended my 4 day long hunt! God Bless you man.
Have a great day. Bye
[…] Fraudblawg previously reported, the Wall Street Journal ran an article in April, 2010, publishing the results of a study conducted by Yale University professor Henry Dove that strongly […]