OIG Audit Reveals Lack of Data Sharing Led to $128M in Duplicate Payments by Medicare, VA

Fierce Healthcare / By Annie Burky
 
Medicare paid for medical services that the Veterans Health Administration (VHA) had also paid for, resulting in duplicate payments of up to $128 million over five years, revealed an audit performed by the Office of Inspector General (OIG).
 
The federal oversight agency reported that Medicare could have avoided the loss if proper controls had been implemented.
 
The audit, performed by the Department of Health and Human Services’ OIG, reviewed Medicare and VHA benefits paid for by the VA’s community care programs. The audit covered $19.2 billion in Medicare Parts A and B payments for 36.3 million claims for individuals eligible for Medicare and VHA benefits who received services from VA’s community providers. The audit period spanned from January 2017 through December 2021 and sought to identify duplicate payments.
 
“These duplicate payments occurred because [the Centers for Medicare & Medicare Services (CMS)] did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits,” the report said.  “Specifically, CMS did not establish a data-sharing agreement with VHA for the ongoing sharing of data between the two agencies and did not develop an interagency process to include VHA enrollment, claims and payment data in CMS’s data repository.”
 
VA’s community care program offers veterans who are unable to easily access a VHA facility the option to receive care through community providers. Said providers participate in Medicare and have entered into agreements with the VA.
 
In the years of the audit, veterans who accessed care at these facilities increased, partially due to the June 2019 expansion of eligibility in the Veterans Community Care Program. During the 2020 fiscal year, roughly 5.6 million individuals were dually eligible for Medicare and VHA benefits.
 
“VHA is solely responsible for paying for the community care services it authorized,” the report said. “Medicare payment for other services not authorized by VA may be made in accordance with Medicare requirements. Duplicate claims occur when a provider submits claims for the same services to both Medicare and VHA, and duplicate payments occur when both programs pay the claims.

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Interim HealthCare CEO: ‘No action’ Behind Biden Executive Order

Newsmakers Podcast (AUDIO Podcast) / By Liza Berger
 
Interim HealthCare President and CEO Jennifer Sheets told McKnight’s Home Care Daily Pulse the Biden administration’s recent executive order directing more resources into the home falls short at a time when the Centers for Medicare & Medicaid Services is cutting home health rates. In this Newsmakers podcast, Sheets talks about how she plans to advocate for the industry in her new role as board chair of the Research Institute for Home Care.

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Casey Introduces Bill to Increase Funding for Direct Care Workforce

McKnight’s Home Care / By C. MAX BACHMANN
 
Sen. Bob Casey (D-PA), chair of the U.S. Senate Special Committee on Aging, introduced a bill Wednesday that would increase funding and training for direct care workers and caregivers, bolstering the HCBS Access Act. 
 
The Supporting Our Direct Care Workforce and Family Caregivers Act would award grants to states and eligible groups to increase the direct care workforce and also train paid and unpaid family caregivers. The legislation is part of Casey’s HCBS Access Act, which he introduced in March. Direct care workers include home health and personal care aides and certified nursing assistants who provide long-term care services, the bill notes. 
 
“The caregiving crisis in this country corners many Americans into upending their careers and living on poverty wages or performing unpaid caregiving for family members because they have no other options,” Casey said in a statement Wednesday. “This is not the way that a great nation treats its workers and families. This legislation would ensure that paid caregivers can receive family-sustaining wages and continue to provide essential care to older adults and people with disabilities.”
 
Seven other senators joined Casey in introducing the bill, including fellow Senate Special Committee on Aging Member Kirsten Gillibrand (D-NY), and Sens. Tim Kaine (D-VA), Maggie Hassan (D-NH), Jack Reed (D-RI), Tina Smith (D-MN), Sheldon Whitehouse (D-RI) and Ron Wyden (D-OR).
 
In a press release, the committee cited shortages and low wages in the direct care workforce — a 2022 study from PHI said the median wage of direct care workers was just over $14 — as justification for the bill. 
 
The Supporting Our Direct Care Workforce and Family Caregivers Act and HCBS Access Act were preceded by the Better Care Better Jobs Act, which Casey reintroduced in January.

Behind The Emerging Trend Of Self-Directed Home-Based Care In The US

Home Health Care News / By Patrick Filbin

More home-based care agencies are turning to family members and loved ones to fill staffing needs. This is the case with both seniors and children being cared for in the home. Even the White House has recently been supportive of the paid family caregiver model.

A recent study from Northwestern University could also bolster support. It found that children who received care from family members trained as CNAs were not more likely to be hospitalized compared to children cared for by traditional CNAs.

The study also found children cared for by family members experienced greater care continuity because turnover was not as much of an issue.

“We’ve known for a long time that children with disabilities and chronic conditions at home have had trouble accessing in-home care,” Carolyn Foster, a pediatric researcher at the Ann and Robert H. Lurie Children’s Hospital in Chicago, told Home Health Care News. “There was already an underlying problem of having trouble getting people to work in the home health care industry. Now there’s research that shows parents of children who have medical needs will have to essentially drop out of the workforce to provide their child services because they have trouble getting an in-home provider.”

The same can be said for the senior and special needs populations…

…The flexibility to pay family members through Medicaid for home-based care services varies by state. Some states won’t allow a family member to be paid for those services at all.

Others, like Colorado, have gone above and beyond to make it easier for family members to become paid caregivers.

Colorado’s Medicaid program – which was at the center of the Northwestern study – will assist family members to become licensed CNAs, which allows home health agencies to hire those family members.

“We were interested in seeing whether those kids were more likely to get hospitalized, if they got sick more often and what the costs looked like,” Foster said. “We ultimately found that, at least for the number of hospitalizations, it was the same. We also found – which was kind of profound but not really surprising – that there was this incredible continuity in care. A huge problem for these kids is that even if they do get a home health care provider, there’s huge turnover and the people who take care of them don’t get to know them very well and then leave their job.”

The same issues exist in home-based senior care…

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