In 2008, in order to combat the increasing amount of fraud by home health agencies, the Florida legislature instituted a mandatory quarterly reporting by all agencies of the following:
- Number of insulin-dependent diabetic patients receiving insulin injection services
- Number of patients receiving home health services from the home health agency AND a licensed hospice provider
- Total number of patients receiving home health services
- The names and license numbers of nurses (RN’s or LPN’s) whose primary job responsibility is to provide home health services to patients and received remuneration in excess of $25,000 for the three months of the quarter
The data from each quarter’s report is shared with the federal Centers for Medicare and Medicaid Services (CMS) and added to other sources of information to develop anti-fraud campaigns.
A home health agency’s failure to submit the quarterly report results in a $5,000 fine. According to the Professional Staff of the Committee on Appropriations of the Florida Senate, “from January 1, 2009 through December 31, 2012, there were a total of 1,407 fines imposed. For the most recent state fiscal year, fines of $932,750 were imposed by final order.” The magnitude of the fines has, among other things, caused some small agencies to close.
Moreover, private duty agencies are not able to provide services to Medicare members, and most are paid by the client’s private funds or long-term care insurance. The Home Care Association of Florida claims that of the 380 private duty agencies fined in Florida, 200 went out of business after being fined.
Good news! Effective July 1, 2013, the law has since been amended to:
- Reduce the fine amount levied against HHAs that fail to file a quarterly report to the AHCA, within 15 days after the end of each calendar quarter, from the current fine of $5,000 to a fine of $200 per day up to a maximum of $5,000 per quarter; and
- Exempt HHAs that do not bill Medicare or Medicaid, and are not owned by a health care entity which bills Medicare or Medicaid, from the fine for failing to file the quarterly report.
Home health agencies that bill CMS are still required to submit the quarterly report but the change in the fines allows some flexibility for those agencies that miss the deadline by a few days.