Acadiana Business

LHC Group part of Senate investigation on Medicare reimbursements

by Leslie Turk

A U.S. Senate committee is investigating whether Lafayette-based LHC Group and three other home health providers deliberately scheduled certain home therapy visits in order to trigger higher Medicare reimbursement.

At about 7 p.m. Wednesday, Lafayette-based home health provider LHC Group e-mailed a statement confirming its receipt of a May 12 letter from the U.S. Senate Finance Committee regarding an investigation into its practice of providing in-home therapy visits that are reimbursed by Medicare. Prompting the Senate inquiry was an April 26 story in the The Wall Street Journal, "Home Care Yields Medicare Bounty," which described how several home health companies' Medicare patients received a high number of the most profitable therapy visits, but few of the least profitable ones.

The committee launched an investigation into the practices of Baton Rouge-based Amedisys Inc., the nation's largest home health-care company, LHC Group and two other companies. It hopes to determine whether the companies deliberately boosted the number of home therapy visits to trigger higher Medicare reimbursements. The home therapy numbers cited in the WSJ article came from publicly available Medicare claims.

"The Committee has asked us to respond to some questions regarding therapy utilization in prior years, and we intend to cooperate with the request," LHC Group writes. "Although our response will contain a comprehensive analysis, we wanted to take this opportunity to provide a few of the key facts that will be included in our response."

As a company, therapy represents a much lower portion of our episodes than the national average. In 2007, 36.6% of our total Medicare episodes received therapy versus the national average of 49.8%, and only 38.2% of our total Medicare episodes in 2008 received therapy versus the national average of 50.2%.
All home care services, including therapy, are dictated by an independent physician order.
The average number of therapy visits received by our top 20 patient diagnoses that required therapy in 2007, as compared to those same patient diagnoses in 2008, was consistent despite the change in therapy thresholds from 2007 to 2008. In fact, in none of those top 20 diagnoses did the average visits increase to a level that would result in our meeting or exceeding a higher therapy threshold.
The Wall Street Journal article assumes a static patient population when in fact, due to growth resulting from industry consolidation, our home health patient population on December 31, 2007, was 17,850, and on December 31, 2008, our home health patient population was 26,163, an increase of 46.6%. During this same period, our home health locations increased from 144 to 206. We also increased the number of states in which we operated from 11 to 17. As a result of this growth, the make-up of our top 20 patient diagnoses in 2007 was very different from our top 20 patient diagnoses in 2008.
Since 1996, we have maintained a corporate compliance program and an employee compliance hotline operated by an independent third party.

Read LHC Group's full letter here and today's WSJ story here.