STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No,: 2010008044 vs. FOCUS MANAGEMENT ASSOCIATES, LLC, d/b/a FOCUS HOME HEALTHCARE, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (the ‘Agency”) and files this administrative complaint against Focus Management Associates, LLC, d/b/a Focus Home Healthcare (“Respondent”) and alleges: NATURE OF THE ACTION This is an action to impose a fine in the amount of forty- five thousand dollars ($45,000.00), and such additional remedy as is deemed just by this tribunal including costs of investigation, pursuant to Chapter 400, Part III, Florida Statutes, and Rule 59A-8.0185, Florida Administrative Code. ‘JURISDICTION AND VENUE 1. The Agency has jurisdiction over the Respondent pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes. 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. Page 1 of 11 Filed September 13, 2010 3:43 PM Division of Administrative Hearings. PARTIES 3. The Agency is the licensing and enforcing authority -for home health agencies pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes, and Chapter S59A-8, Florida Administrative Code. 4. Respondent is a home health agency located at 200 South Hoover Boulevard, Suite 160, Tampa, Florida 33609, having been issued license number 299992496. 5. Respondent is certified as a Medicare and Medicaid provider. 6. At all times material to the allegations of this administrative complaint, Respondent was a home health agency licensed under the licensing authority of the Agency and was required to comply with all applicable rules and statutes. COUNT TI H365 7. The Agency re-alleges and incorporates paragraphs one (1) through six (6), as if fully set forth in this count. 8. Section 400.474, Florida Statutes, provides: 400.474 Administrative penalties. -- (1) The agency may deny, revoke, and suspend a license and impose an administrative fine in the manner provided in chapter 120. (2) Any of the following actions by a home health agency or its employee is grounds. for disciplinary action by the agency: (a) Violation of this part, part II of chapter 408, or of applicable rules. (4) The agency shall impose a fine of $5,000 against a home health agency that demonstrates a pattern of Page 2 of 11 billing any payor for services not provided. A pattern may be demonstrated by a showing of at least three billings for services not provided within a 12-month period. The fine must be imposed for each incident that is falsely billed. The agency may also: (a) Require payback of all funds; — (b) Revoke the license; or (c) Issue a moratorium in accordance with a, 408.814. 9, Section 400.484, Florida Statutes, provides: 400.484 Right of inspection; deficiencies; fines. -- (1) In addition to the requirements of s. 408.811, the agency may make such inspections and investigations as are necessary in order to determine the state of compliance with this part, part II of chapter 408, and applicable rules. (3) In addition to any other penalties imposed pursuant to this section or part, the agency may assess costs related to an investigation that results in a successful prosecution, excluding costs associated with an attorney's time. 10, The Agency completed a complaint investigation survey of the Respondent on July 12, 2010. 11. Based on review of clinical records, policies and procedures, memos, supply requisition forms, Respondent's billing documentation, and staff interviews, the Agency determined that the Respondent home health agency billed Medicare for services not rendered, in three of three patients’ clinical records reviewed and in nine of nine individual billing episodes reviewed for those three patients. 12. Review of Patient #1's clinical record revealed a start of care date of 4/5/10. There was no documentation and/or valid documentation of requests for medical supplies in Patient Page 3 of 11 #1's clinical record. There were two medical supply requisition forms in the chart dated 4/21/10 and 6/2/10, There were no signatures on the areas for authorizing signatures that the request was approved and/or the patient received the supplies. Neither form was signed by authorized personnel and the form dated 6/2/10 did not indicate how many of the items were needed. 13. Additionally, the Respondent home health agency was unable to provide any further documentation/evidence as to exactly what supplies the patient received versus for what Medicare was billed. 14. Review of Patient #2's clinical record revealed a start of care date of 04/08/10. There was no documentation and/or valid documentation of requests for medical supplies in Patient #2's clinical record. There was one medical supply requisition form in the chart dated 04/08/10. There was no signature on the area for authorizing signatures that the request was approved and/or the patient received the supplies and the form fails to indicate how many of the items were needed, 15. Additionally, the Respondent home health agency was unable to provide any further documentation/evidence as to exactly what supplies the patient received versus for what Medicare was billed. 16. Review of.Patient #3's clinical record revealed a Page 4 of 11 start of care date of 03/31/10. There was no documentation of any requests for medical supplies in Patient #3's clinical record. 17. Additionally, the Respondent home health agency was unable to provide any further documentation/evidence as to exactly what supplies the patient received versus for what Medicare was billed. 18. The Agency surveyor’s review of Respondent's policies and procedures manual failed to reveal any policies or procedures related to supply usage, ordering, tracking, or billing. 19. A memo dated 04/14/10, from the Respondent’‘s Administrator to office staff stated: "Please note that ordering of supplies needs to be closely monitored and properly documented. Effective immediately, the ordering of supplies needs to be documented via supply ordering form that needs to be reviewed and signed off by case managers prior to completing the final bill audit that is being submitted to Cynthia Paul." 20. The Agency’s surveyor made a request for documentation of the bills submitted to Medicare for the patients. Review of the Medicare billings provided by Respondent to the Agency's surveyor revealed there were supplies listed on each billing episode as follows and all supplies were listed as "Non-Routine" and "1" Service Unit: Page 5 of 11 20.a) Patient #1: 04/05/09-06/03/09, $375.00; 06/04/09-08/02/09, $175.00; 08/03/09-10/12/09, $375.00; 10/02/09-11/30/09, $175.00; 12/01/09-01/29/10, $175.00; 01/30/10-03/30/10, $40.00; 03/31/10-05/29/10, $40.00. There were no further details listed as to what the supplies were. 20.b) Patient #2: 04/08/10-06/06/10, $40.00 20.¢c) Patient #3: 03/31/10-05/29/10, $40.00 21. %In an interview with the Biller for Medicare, on 7/12/10 at approximately 11:00 a.m., the Biller confirmed the Agency surveyor’s findings. She indicated there is a supply list called Medical Supply Requisition ("MSR”) which the skilled nurses (“SN”) are required to fill out and then they give it to the Case Manager or Managers. Her desk is actually located in the supply room and she said she tries to remind the nurses every time they enter the room that if they are taking out supplies they need to fill out and turn in the MSR form. "You tell them and you tell them but they just don't get the importance of this and that it is company policy." She stated the process is that the SN fills in the patient's name and the .date on the MSR form, chooses the supply needed and marks how many of them are needed and writes in any supplies needed that are not already preprinted on the form. The MSR form is to then to be given to the Case Manager (“CM”) or Director of Nursing (“DON”) who approves the need for the supplies and then this Page 6 of 11 information is to be entered in Visitrak, a tracking/billing system the Respondent home health agency utilizes. Then "I get a paper that has the patient's name and episode on it from the case manager that lets me know when to bill a patient episode." The CM or DON enter supplies and visits in Visitrack and the software generates the claim and it is then submitted electronically. The MSR form is then supposed to be placed into the patient's clinical record, 22. The Biller reviewed patient clinical records for Patients #1, #2, and #3 to review for documentation of MSR forms in patient records. She was only able to find one form in Patient #1's clinical record dated 4/21/10. There was no further documentation of any MSR forms in the clinical record for Patient #1, #2, or #3. 23. The Agency’s surveyor conducted an interview with the Administrator, Co-Owner, and RN #2 on 7/12/10 at approximately 2:00 p.m. Questions and responses were as follows: 23,a) Are there were any policies and procedures related to medical supplies and billing? Co-owner, "Only a memo to the staff." She provided a copy of memo. 23.b) Did anyone at the Respondent home health agency bill Medicare patients directly for supplies or services? Co- owner - "Never" 23.c) How can you tell what supplies are used for a Page 7 of 11 patient as opposed to what was ordered in general or specifically for patients? Co-owner - "They should be able to tell by having a discussion. The skilled nurse in the field should be telling the case manager what was used. Nurses in the field make multiple request forms for patients. We have assumed that what was ordered was used. Maybe this is a mistake to assume this." 23.d) What is your checks and balance system for supplies? Co-owner - "Case manager and biller - it's between them. They have to verify what they used and what they billed. . 24. %In the presence of RN #2, Respondent’s Administrator and Respondent's co-owner, the Agency’s surveyor interviewed RN #1 on 7/12/10 at approximately 2:30 p.m, RN #1 is the Respondent's staff nurse who has provided services to Patient #1. RN #1 stated to her knowledge the patient "had been buying his/her own supplies" and only now "the last time, the last month” was the Respondent home health agency being responsible for getting the patient her supplies. At this point, the Co- owner denied that she was aware of this; she stated to her knowledge the Respondent home health agency had been getting the patient's supplies. 25. Interview with the Respondents administrator and co- owners on 7/12/10 at approximately 5:00 p.m. revealed they had Page 8 of 11 no further documentation to provide and confirmed/agreed with findings. 26. As set forth above, during a:twelve month period Medicare was billed for supplies for Patient #1 on seven (7) occasions, but Respondent had no documentation of what supplies were billed to Medicare, and Respondent had no documentation that Patient #1 ever received whatever was billed to Medicare. Moreover, Respondent’s employee who wag Patient #1’s caregiver stated to the Agency's surveyor that during this period Patient #1 purchased the supplies used for Patient #1. Also as set forth above, the records of two other of Respondent's patients, Patients #2 and #3, similarly each showed one bill to Medicare for which Respondent had no documentation of what supplies were billed to Medicare, and Respondent had no documentation that Patient #1 ever received whatever was billed to Medicare. These facts demonstrate a pattern of billing Medicare for services not provided, and warrant a fine of $5,000 for each of the nine Medicare billings. WHEREFORE, the Agency intends to impose a fine in the amount of forty-five thousand dollars ($45,000.00) plus investigative costs to be determined by this tribunal, pursuant to Chapter 400, Part III, Florida Statutes, and Rule Chapter 59A-8, Florida Administrative Code. Page 9 of 11 NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 32308, whose telephone number is 850-412-3630. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the ‘foregoing has been served by U.S. Certified Mail, Return Receipt No. 7009 3410 0000 0172 6378 to Phillip Krivoruk, Administrator, Focus Home Healthcare, 200 South Hoover Boulevard, Suite 200, Tampa, Florida 33609, and by regular U.S. Mail to Natalie Krivoruk, Registered Agent for Focus Management Associates, LLC, 200 South Hoover Boulevard, Suite 200, Tampa, Florida 33609, on August {9 , 2010. \\ sens of Hse es H, Harris, Esq. sgistant General Counsel. Fla. Bar. No. 817775 Agency for Health Care Administration 525 Mirror Lake Drive, 330D . St. Petersburg, Florida 33701 727-552-1944 (office) 727-552-1440 (facsimile) Page 10 of 11 Copies furnished to: Phillip Krivoruk, Administrator, Focus Home Healthcare 200 South Hoover Boulevard, Suite 200 Natalie Krivoruk, Registered Agent for Focus Management Associates, LLC 200 South Hoover Boulevard Tampa, Florida 33609 Suite 200 (U.S. Certified Mail) Tampa, Florida 33609 (U.S. Mail) James H, Harris, Esquire Agency for Health Care Admin. 525 Mirror Lake Drive, #330D St. Petersburg, FL 33701 (Interoffice Mail) Patricia R. Caufman Field Office Manager 525 Mirror Lake Dr., 4™" Floor St. Petersburg, Florida 33701 (Interoffice) Page 11 of 11 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: Focus Management Associates, LLC, CASE NO. 2010008044 d/b/a Focus Home Healthcare ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Impose a Late Fee, Notice of Intent to impose a Late Fine or Administrative Complaint. If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT QNLY 1 OF THESE 3 OPTIONS OPTION ONE (1), I admit to the allegations of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) I admit to the allegations of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where 1 may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3)____I dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.

Docket for Case No: 10-009052