Subject: Godsend for Many, Home-Care Also Has Potential for Fraud And Abuse 
Date: Published: 11/21/91 (147 lines)
Source:  Wall Street Journal.  Copyright Dow Jones & Co. Inc. 

    Health:
    Godsend for Many, Home-Care Industry
    Also Has Potential for Fraud And Abuse
    ----
    By Hilary Stout
    Staff Reporter of the Wall Street Journal

    After two months in the hospital and seven months in a
 nursing home, William Brockmeyer was ready to go home.  But
 with his left side paralyzed from a stroke, the 87-year-old
 man from New York's Long Island couldn't manage alone.
 Relatives hired a home health aide from a local firm to help.
    On his first day on the job in 1989, the aide, 27-year-old
 Victor Bell, robbed and killed Mr. Brockmeyer.  He was later
 convicted of murder.
    The tragedy is an extreme example of an increasingly
 pressing problem:  how to protect the consumer in the hugely
 diverse, rapidly expanding home health-care industry.
    Of all the segments of the U. S. economy's burgeoning
 health-care sector, none is growing faster than home care.
 Last year alone, there were more than 1,500 new firms
 offering nursing and personal care in the home, according to
 the National Association for Home Care.  The home
 medical-equipment industry has grown even faster, expanding
 by about 15% a year, to about 7,000 or 8,000 firms, according
 to a spokesman for the National Association of Medical
 Equipment Suppliers.
    The industry is a godsend for many, allowing AIDS patients
 escape from hospital beds, frail elderly an alternative to
 nursing homes, kidney patients relief from having to undergo
 regular hospitalization for dialysis, premature babies the
 chance to come home.  Moreover, it has become a darling of
 Wall Street investors, convinced that the growing push for
 outpatient medical services and the aging population will
 keep the industry growing apace.
    But the rapid growth of private care also raises concerns
 among many consumer advocates.  "The main thing with home care
 is the potential for fraud and abuse is staggering," says
 Maria Mitchell, president of the Community Health
 Accreditation Program, a subsidiary of the National League of
 Nursing, which was founded four years ago to accredit home
 health-care firms.  "One can only shudder to think what can go
 on in the home if we don't have the means to measure and
 assess quality."
    Such concerns involve potential financial abuse as well as
 shoddy care.  Government prosecutors allege in federal court
 in Philadelphia that Federal Home Care Inc. telephoned senior
 citizens to offer medical equipment that would be covered by
 Medicare, the federal health-insurance program for the
 elderly and the disabled.  In the telephone conversations,
 company officials were able to obtain senior citizens' Social
 Security numbers, the government alleges.  The firm then
 shipped unneeded equipment to the homes of elderly people and
 billed the government, prosecutors allege.  The court is
 reviewing allegations that the company submitted more than $8
 million in fraudulent claims to Medicare.  Federal Home Care
 denies the allegations.
    The Bush administration this month unveiled regulations to
 crack down on the home medical-equipment industry, including
 a rule that suppliers meet a set of standards in order to do
 business with Medicare.  Bills have already been introduced in
 both the House and the Senate that would require home
 medical-equipment suppliers to meet Medicare's standards of
 practice.  The home-care industry supports the effort.  "This
 industry is bound and determined to change our image around
 and really boot the bad players out," says Ramon Paquette,
 president of Vermont Medical Home Care Inc. 
    No one is saying the home-care business is an industry of
 scoundrels.  "I think it's a very valuable service, and there
 are a lot of very competent, high-level providers in the
 industry providing services and maybe even more attention
 than in the hospital," says William Thompson, vice president
 of a Burlington, Vt., insurance company that underwrites
 policies for home-care providers nationwide.  "But I think
 it's important for consumers to look for signs of quality in
 agencies, maybe memberships in national associations,
 accreditation, history."
    The industry encompasses uneducated, minimum-wage aides
 hired to clean house and bathe invalids; visiting-nurse
 agencies that provide highly trained registered nurses and
 nurse practitioners; companies that sell or rent medical
 technology from wheelchairs to home respirators; and firms
 that provide people and equipment to administer infusions of
 nutrients and medicines, procedures that in the past had to
 be done in hospitals.
    The most frequent charge against home-care firms is
 unreliability.  People show up late or don't show up at all.
 But there are far more serious problems.  Mr. Thompson recalls
 receiving claims in some half-dozen cases in the past three
 years where nurses or home health aides have murdered
 patients.  Numerous other claims have been filed against home
 health companies alleging that home health aides and visiting
 nurses stole jewelry and credit cards and forged the checks
 of their patients, he says.
    Other problems reflect those that occur throughout the
 health-care industry:  padded bills, charging for services or
 equipment that isn't needed or referrals to agencies by
 physicians who have an ownership stake in the firm.  The
 Department of Health and Human Services is investigating
 whether one of the oldest and most successful home-care firms
 -- Caremark, a unit of Baxter International Inc. that sells
 medical equipment for use in the home -- illegally paid
 doctors to refer patients to the company.  Caremark denies any
 wrongdoing.
    In a recent report by Congress's General Accounting Office
 cited a Florida case in which a doctor and nurse showed up at
 an elderly woman's home claiming that Medicare had sent them
 "because elderly people were dying due to inadequate care."
 The couple had nothing to do with the Medicare program.  But
 later in the day, several types of medical equipment were
 delivered and $773.71 was charged to Medicare.
    Critics say regulation often is lacking.  "Home care can be
 abused care," says Charles Inlander, president of the
 People's Medical Society, the largest consumer health
 organization in the country.  "There's no public eye there."
    States regulate home care in different ways, and only some
 require licensing.  Any firm that wishes to participate in the
 Medicare program (which doesn't cover much home care anyway)
 must receive government certification, but only about 5,700
 of the 12,500 home-care firms in the U. S. are certified,
 according to the National Association for Home Care.
    A few private bodies also accredit home-care firms.
 Currently, two major accreditors are locked in a battle for
 dominance that could determine the direction of the oversight
 system.  One is the Joint Commission on Accreditation of
 Health Care Organizations, which is basically run by
 representatives of health-care providers and which keeps its
 operations and findings secret.  The other is the
 four-year-old Community Health Accreditation Program, which
 includes consumer representatives on its board and makes
 findings of any firm it reviews available to the public.
    But monitoring what goes on in the hundreds of homes
 handled by a single firm isn't so easy.  "In that sense, it's
 a bit of a regulator's nightmare," says Rick Surpin,
 president of Cooperative Home Care Association, a New York
 City company that provides nurses aides and other
 paraprofessionals to work in private homes.  "It's not like
 you can go into a hospital and inspect everyone," he says.
 "You're really putting a great deal of trust in the agency."

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