By TERRI LANGFORD, HOUSTON CHRONICLE
The nation's Medicare program has dished out $1.25 billion for home-based health care in Houston over four years - and yet nearly every agency that provides nurses, therapists and drugs for the elderly and disabled has violated state and federal standards, a Houston Chronicle investigation has found.
Still, little stops the flow of taxpayer dollars to the nearly 470 companies based in America's fourth largest city.
Dubbed "deficiencies" by the Texas Department of Aging and Disability Services, they include violations like failure to make sure drugs and treatments are administered properly and failure to report abuse of a patient.
Federal authorities say not only are companies falling short on certain standards of care, some also are bastions for potential fraud - its victims patients and taxpayers.
Though federal authorities declined to provide details, citing ongoing investigations, Assistant U.S. Attorney Justo Mendez told the Chronicle that some of the company billings in Houston are the result of "fraudsters" who "bill for services not rendered."
Earlier this year, Houston's Craig O'Connor was witness to the wiles of the industry.
His elderly mother, suffering from a poorly healed wound on her foot, was sent home from the hospital with a recommendation to use a home health care agency to help her recovery. Instead, he says his mother's convalescence was turned upside down as workers from the recommended company made a beeline to his mother's door.
"This was my first experience with Medicare, and I quickly became alarmed about all the doctors and health aides who were practically falling all over themselves to schedule house calls to see my mother," O'Connor recalled.
One of the "doctors" who showed up wasn't even really a doctor, he said.
Federal auditors repeatedly have noted the exploding and profitable growth of home health care in the Lone Star State, where Medicare spending has blown up to three times the national growth rate.
The Chronicle's examination of payment records showed that even in the tiny town of Edinburg in South Texas, 27 home health care agencies have received $331 million over the last four years.
Two months ago, a Chronicle investigation of the private ambulance business found millions in Medicare dollars spent on questionable transports of able-bodied patients to mental health clinics.
Booming business
Houston's Harris County leads the nation in the number of nonemergency ambulances, companies and Medicare billings with more than $62 million coming to some 400 companies in 2009 alone.
And yet, the home health care industry is even larger - and richer: $384 million was paid to 468 Houston companies in 2010.
Like private ambulances, no one state agency is charged with determining how much money is too much, or how many companies are too many. And Medicare's direct contact with the companies that bill the mammoth insurance agency for the elderly and disabled is minimal.
The Centers for Medicare and Medicaid Services, or CMS, delegates nearly all of its authority to contractors, a mix of private companies and state agencies. Those contractors, not the federal agency, decide what companies qualify for Medicare and pay the patients' bills.
'Termination track'
In Texas, it's the state Department of Aging and Disability Services, or DADS, that does the licensing, inspecting and investigating of home health agencies - a chore it is contracted to do for Medicare as well.
If the agency finds federal violations that endanger a patient's health, the report is sent to CMS and a "termination track" clock begins. The company has 90 days to correct the problems, with DADS in charge of checking back.
Through all of this, however, no one from the $760-billion CMS ever sets an eyeball on a home health agency in Houston, where 289 companies have collected $1 million or more from 2007 through 2010.
Last year, 129 companies hit the $1 million Medicare mark.
Dubbed "deficiencies" by the Texas Department of Aging and Disability Services, they include violations like failure to make sure drugs and treatments are administered properly and failure to report abuse of a patient.
Federal authorities say not only are companies falling short on certain standards of care, some also are bastions for potential fraud - its victims patients and taxpayers.
Though federal authorities declined to provide details, citing ongoing investigations, Assistant U.S. Attorney Justo Mendez told the Chronicle that some of the company billings in Houston are the result of "fraudsters" who "bill for services not rendered."
Earlier this year, Houston's Craig O'Connor was witness to the wiles of the industry.
His elderly mother, suffering from a poorly healed wound on her foot, was sent home from the hospital with a recommendation to use a home health care agency to help her recovery. Instead, he says his mother's convalescence was turned upside down as workers from the recommended company made a beeline to his mother's door.
"This was my first experience with Medicare, and I quickly became alarmed about all the doctors and health aides who were practically falling all over themselves to schedule house calls to see my mother," O'Connor recalled.
One of the "doctors" who showed up wasn't even really a doctor, he said.
Federal auditors repeatedly have noted the exploding and profitable growth of home health care in the Lone Star State, where Medicare spending has blown up to three times the national growth rate.
The Chronicle's examination of payment records showed that even in the tiny town of Edinburg in South Texas, 27 home health care agencies have received $331 million over the last four years.
Two months ago, a Chronicle investigation of the private ambulance business found millions in Medicare dollars spent on questionable transports of able-bodied patients to mental health clinics.
Booming business
Houston's Harris County leads the nation in the number of nonemergency ambulances, companies and Medicare billings with more than $62 million coming to some 400 companies in 2009 alone.
And yet, the home health care industry is even larger - and richer: $384 million was paid to 468 Houston companies in 2010.
Like private ambulances, no one state agency is charged with determining how much money is too much, or how many companies are too many. And Medicare's direct contact with the companies that bill the mammoth insurance agency for the elderly and disabled is minimal.
The Centers for Medicare and Medicaid Services, or CMS, delegates nearly all of its authority to contractors, a mix of private companies and state agencies. Those contractors, not the federal agency, decide what companies qualify for Medicare and pay the patients' bills.
'Termination track'
In Texas, it's the state Department of Aging and Disability Services, or DADS, that does the licensing, inspecting and investigating of home health agencies - a chore it is contracted to do for Medicare as well.
If the agency finds federal violations that endanger a patient's health, the report is sent to CMS and a "termination track" clock begins. The company has 90 days to correct the problems, with DADS in charge of checking back.
Through all of this, however, no one from the $760-billion CMS ever sets an eyeball on a home health agency in Houston, where 289 companies have collected $1 million or more from 2007 through 2010.
Last year, 129 companies hit the $1 million Medicare mark.
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