BATON ROUGE, La. (AP) — In-home health providers who care for Louisiana Medicaid patients say they have been unfairly targeted by health department audits that claimed they owed $4.2 million in overpayments and fines, and nearly every provider sanctioned is appealing the decision.
Jacquelyn Blaney, who runs a Baton Rouge in-home care firm, said in many instances the providers were improperly penalized even though they followed Department of Health and Hospitals rules. She said providers have been unable to obtain details about how the penalties were decided.
“We can’t find any rhyme or reason to the numbers. It seems arbitrary at best,” said Blaney, founder of the Louisiana Supported Living Network.
Forty-one companies were reviewed by accounting firm Postlethwaite & Netterville.
DHH officials said the audits turned up insufficient documentation for worker training, a lack of criminal background checks on employees, timesheet discrepancies and, in one instance, outright fraud that was referred to Attorney General Buddy Caldwell’s office for review.
Kimberly Sullivan, the program integrity chief for the state’s Medicaid program, said Tuesday that home health care providers haven’t been charged the penalties yet and can shrink the money owed if they can provide missing documentation and reconcile inconsistencies.
Forty of the 41 audited companies are either asking for the penalties to be revisited through an informal review process or through a formal appeals process, Sullivan said.
The reviews, conducted over the fiscal year that ended in July, were part of a DHH program specifically targeting home health care providers, who care for elderly and disabled residents with tasks that range from helping with baths and meals to hours of constant monitoring. More than 1,900 companies provide home health care services paid through Medicaid, a government-run insurance program funded with a mix of state and federal dollars.
Jerry Phillips, undersecretary of the health department, said DHH focused on the home health care businesses because previous reviews have shown high error rates in documentation. The health department will use the audit findings to change its monitoring policies.
“We’re having to scrutinize to weed out bad providers and to improve the rules,” Phillips said.
In recent years, in-home service programs through Medicaid have grown substantially amid a nationwide push to keep people out of institutions, nursing homes and developmental centers when they can be cared for at home or in their communities.
“They reason they get audited more often is because we get complaints,” Sullivan said.
Home health providers and advocacy leaders say they feel unfairly targeted by a health department that they say favors institutional care and nursing homes, a claim that DHH officials deny.
“We don’t have problems with the audits. We would like them to be fair,” said Blaney, who is appealing a $150,000 penalty from her most recent audit.
Blaney estimated as much as 80 percent of the overpayments and fines levied in the Postlethwaite audits were tied to the lack of updated care plans for patients, even though that requirement was suspended by DHH.
Sullivan acknowledged her office wasn’t aware of the suspension, but she said the auditing firm has been notified and will review those penalties. She said she doesn’t think the percentage is as high as Blaney suggested. She didn’t have an estimate of what amount might be reversed in audit fines.
In-home care providers said those types of errors in audits cost them time and money to defend against the allegations.
Janis Anderson, who works at a Bunkie home health company, said a previous audit initially penalized Sylvia’s Caring Companions Health Care Services more than $80,000, but a series of follow-up reviews cut the money owed down to $348. She said she expects similar reductions in the Postlethwaite appeals.
“It is a vigorous process, distracting from our real work,” Anderson said.