How to Respond to Latest Home Care News From Texas?

Once again last week, home care was in the news in a major press statement from CMS and on national television.  Unfortunately,  the stories weren’t about the patients and families receiving incredible comfort and care from our skilled teams, or about hospitalizations prevented,  or healing advanced.  The news was about the indictment of Dallas physician Jacques Roy –  accused of running a 485 factory that “certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States.”  Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years, for services totaling $375 million. Five people have been indicated and Medicare payments to 78 agencies have been suspended.

The Home Care Alliance of Massachusetts has tried to lead when it comes to ensuring an industry that is ethical and trusted by patients and referrals sources. Several years ago, we added a Code of Business Ethics to our membership application. We have taken a strong stand against unchecked growth, supporting language in the Affordable Care Act that gives the federal EOHHS Secretary to impose temporary moratoriums in areas that have sufficient coverage and unsustainable growth. In 2010, we suggested in a letter to Secretary Sebelius that the the 25% growth of new agencies in four years in Mass deserved some EOHHS attention.  We have expressed concerns to federal and state regulators about the deemed accreditation process, whereby new agencies gain entry into the market, and about the need to make it more rigorous, We have published – mostly for our referral partners in physicians offices and assisted living – several pamphlets (“Keeping It Legal”)  on referrals, kickbacks and other prohibited practices.

This week we in response to the Texas news, the Visiting Nurse Assoiciation of America called on CMS “to use its authority to put a temporary moratorium on home health until better controls to prevent waste, fraud and abuse can be put in place.   Enforcement,” VNAA said, “is not enough.”

Next week, the Board of Directors of the Home Care Alliance will be meeting.  What do the members think should be our position on the “Texas situation?”


Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

2 thoughts on “How to Respond to Latest Home Care News From Texas?”

  1. I agree that the unfettered growth of agencies has allowed for an increase in fraud and abuse. I do hope that we consider a certificate of need approach in the future across the country to prevent this and encourage a formal vetting process overall. I do not understand in this time period with electronic oversight and statistical analysis, how a 485 mill in Texas can go on so long. In New England , we have had the fortunate model of VNAs that other parts of the country do not have and our traditions of encouraging patient independence and a non-profit model should be replicated instead of the rampant venture capital structure and growth of private companies that seem to look to profits – giving an incentive in the wrong way. At the end of the day we all need to have a positive bottom line but this is of grave concern as we are all tainted by these behaviors. Home Health has always had such a positive reputation, how can we as a group police the agencies that don’t.

  2. Yes I also agree with the growth of fraud today and definitely a certificate should provide to prevent this kind of activities. I really like the post and it increased my knowledge.

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