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.