[authors: Michael Gennett
, Everett Wilson
, and Marisa Rodriguez
Medicare is again revoking the provider numbers of many home health agencies in South Florida, this time on the grounds that they have billed for services which were based on false or forged physician orders. Safeguard Services, LLC, the regional Medicare Zone Program Integrity Contractor, recently completed a series of investigations in which they claim to have obtained statements from physicians who generally denied having referred patients for home health services and/or generally denied that they signed orders for any home health services. As a result, Medicare has commenced revoking the provider numbers of local home health agencies that submitted claims for services ordered by these physicians. In addition to revoking provider numbers, Medicare is also issuing overpayment determinations seeking to recover payments made for services based on these allegedly false orders. Medicare's revocation of provider numbers has also resulted in Florida's Agency for Health Care Administration revoking the home health agencies' state licensure as well.
These revocations and overpayments come with appeal rights, and many home health agencies are already involved in the appeals process. To date, the Medicare contractor has refused to release copies of the alleged physician statements, and it is not certain whether these statements even exist. There appear to be numerous physicians which are at the center of investigation. Through the appeals process, more information will become available. In order for Medicare to uphold these revocations, contractors must prove that these home health agencies knowingly submitted false or fraudulent claims, or that they submitted claims with deliberate ignorance or reckless disregard for their falsity. Medicare has yet to reveal what evidence, if any, they have to support the standard for upholding the revocations.
Akerman currently represents several home health agencies in their appeal of the Medicare revocations, as well as license revocations and overpayment appeals.