Earlier this year when federal officials banned any new home health agencies in Miami-Dade and Monroe counties from participating in Medicare and Medicaid, they called South Florida a “hot spot” for healthcare fraud.
The region remains under the six-month moratorium that began July 30, but existing home health agencies have begun to find ways to stem fraud and abuse on their own.
Virgin Health Corporation, a Miami home health agency founded in 2005, has begun using computer tablets and GPS-based software to verify when its contracted therapists, nurses and medical assistants visit patients at home.
The program, called VisitVerify and developed by Kinnser Software, provides a GPS location and a time and date stamp for each visit to a patient’s home. Patients also are required to sign the tablet, or the worker does not get paid for the visit.
Fernando De la Cruz, chief executive of Virgin Health, said the software program allows him to closely monitor the 80 to 100 home visits conducted by the agency’s workers every day.
“It’s very hard to supervise every single visit with a supervisor following every single nurse,’’ he said.
“There’s a lot of accountability,’’ De la Cruz said, “and there’s no discrepancy of whether a visit was performed or not. We can actually track quality in the sense of how good are employees at meeting appointments with our patients.’’
De la Cruz said the agency used to monitor home visits with telephone surveys of patients and mailers, but those methods are not as reliable as a real-time software program — especially when dealing with patients diagnosed with Alzheimer’s or dementia.
Virgin Health is one of 21 Florida agencies that have used the web-based software to verify clinician visits to patients’ homes, according to a Kinnser press release.
Given Florida’s high population of seniors, the state has a large number of home health providers.
Home health is a less costly method of patient care than long-term hospitalization or nursing home care, but it’s also harder to monitor because homebound patients are dispersed across a wide geographic area.
That has led to widespread abuse of home health care, particularly when it’s reimbursed by Medicare and Medicaid.
During the moratorium announced in July, officials with the federal Centers for Medicare & Medicaid Services said they would monitor home health billing from enrolled providers to root out fraud.
Federal officials identified Miami and Chicago as fraud "hot spots'' by mining data that showed these cities as significant outliers compared to other areas of the country when it comes to home health providers.
CMS found that there were a disproportionate number of home health agencies relative to beneficiaries in Miami and Chicago. The ratio ranged from 327 percent higher than the national average in Chicago, to 1,960 percent higher in Miami.