STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No.: 2011006861 vs. COMPREHENSIVE WELLNESS SERVICES, INC., d/b/a COMPREHENSIVE HOME CARE OF PALM BEACH, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (the “Agency”) and files this Administrative Complaint against Comprehensive Wellness Services, Inc., d/b/a Comprehensive Home Care of Palm Beach (“Respondent”), and alleges: NATURE OF THE ACTION This is an action to impose a fine in the amount of five thousand dollars ($5,000.00) pursuant to Section 400.474, Florida Statutes, for one violation of applicable law. JURISDICTION AND VENUE A The Agency has. jurisdiction over the Respondent. pursuant to Chapters 400, Part III, and 408, Part II, Florida Statutes. 2. Venue lies pursuant to 120.57, Florida Statutes, and Chapter 28, Florida Administrative Code. Page 1 of 13 Filed August.31, 2011 12:28 PM Division of Administrative Hearings PARTIES 3. The Agency is the licensing and enforcing authority for home health agencies pursuant to Chapters 400, Part ITI, and- 408, Part II, Florida Statutes, and Chapter 59A-8, Florida Administrative Code. 4. Respondent is a home health agency with a principal place of business located at 110 Century Boulevard, Suite 102, West Palm Beach, Florida 33417, having been issued license number 299991293, 5. At all times material to the allegations of this administrative complaint, Respondent was required to comply with all statutes and rules applicable to a home health agency licensed in Plorida. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth in this count. 7 Section 400.474(6), Florida Statutes, requires: (6} The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that: oy fetes aetna | tee (e) Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or this chapter from whom the home health agency receives referrals. 8. Section 400.462(27), Florida Statutes, defines: (27) “Remuneration” means any payment or other benefit Page 2 of 13 made directly or indirectly, overtly or covertly, in cash or in kind. 9. From May 26 through May 31, 2011, the Agency conducted a complaint investigation survey of the Respondent. 10. Based on review of Respondent’s documentation -~- including contracts, invoices, and payments -- policies and procedures, and staff interviews, the Respondent home health agency gave remuneration to an assisted living facility-based (the “ALF’s”) staff member, the ALF’s Director of Nursing, and the Respondent home health agency received referrals from the ALF. 11. The Agency’s surveyor reviewed the clinical records of four (4) of Respondent’s patients - Patient #1, #2, #3 and #4 - on 05/26/11, each of whom resided at the ALF while being cared ‘for by Respondent. In reviewing Respondent’s clinical records, the Agency’s surveyor also found: a. Patient #1 and #3 had no documentation of referrals or orders for the Start of Care, for home health services, in their clinical records. form for Respondent’s start of care of Patient #1, including a section for discharge planning, completed by the ALF’s Director of Nursing as an employee of Respondent. c. Respondent’s file.for Patient #3 contained one of Respondent’s forms titled “Comprehensive Home Care: Page 3 of 13 Lotte RESpondentis..file for Patient #1 contained an OASIS ..... Clinical Manager Intake Report” which listed the ALF’s Director of Nursing as “Referring Physician.” d. Respondent’s file for Patient #3 also contained a Comprehensive Adult Assessment, commonly known as an “OASIS” form, completed by the ALF’s Director of Nursing acting as an employee of Respondent and including completing a section concerning Patient #3’s discharge planning. . e. Patient #2's referral form, for the Start of Care of 12/30/10, documented that the referral form was received from the ALF on 12/30/10 at 8:24 AM, as indicated by the facsimile transmittal information. £. Respondent’s file for Patient #2 also contained one of Respondent’s forms titled “Comprehensive Home Care: Clinical Manager Intake Report” which listed the ALF’s Director of Nursing’s role as the Respondent’s Start of Care Nurse and Skilled Nursing Case Manager for Respondent . g. Respondent’s file for Patient #2 also contained a Discharge/Transfer Summary and an OASIS form for the discharge of Patient #2 from Respondent’s care, both completed by the ALF’s Director of Nursing as an employee of Respondent. h. Patient #4 had a referral form for the Start of Care of 03/11/11 that was received from the ALF on 03/11/11 at Page 4 of 13 2:09 PM, as indicated by the facsimile transmittal information. Respondent’s file for. Patient #4 also contained one of Respondent's forme titled “Comprehensive Home Care: Clinical Managez Intake Report” which listed the ALF’s Director of Nursing as the Respondent’s Start of Care Nurse and Skilled Nursing Case Manager for Respondent’ s care of Patient #4. ' . i. On the two referral forms, for Patients #2 and #4, the referral source was "PE," the initials for the ALF, but there was no person documented as the source of the referral. j. The Agency’s surveyor’s further review of the four (4) clinical records revealed that they lacked Start of 1 Care physician's orders. k. Bach record showed that only one nurse, the ALF’s Director of Nursing, visited and provided care to all four (4) patients on behalf of Respondent. 12. In an interview, conducted on 05/26/11 at 11:09 Am with the Respondent’ s only Intake Coordinator, Respondent's Intake Coordinator reported to the Agency’s surveyor that she received and processed referrals for patients. She reported that she usually wrote the name of the person who provided the referral on the referral form, but stated that she was not aware of who provided the referrals to the Respondent for Patients #1, Page 5 of 13 #2, #3 and #4. She stated, during the interview, conducted on 05/26/11 at 11:09 AM, that she also forwarded the referrals to Respondent’s Nursing Department and that Respondent’s Clinical Manager would follow-up and obtain a copy of the physician’s order for the Start of Care, . 13. In an interview, conducted with the Respondent's Director of Nursing (“DON”) on 05/26/11 at 11:13 AM, the DON reported that the Clinical Manager for the four (4) ‘patients was no longer employed by the Respondent, and that the new Clinical Manager had been with the Respondent for approximately one week and would not be able to provide any additional information. 14, The Respondent's DON also reported, during the © interview, on 05/26/11 at 11:13 AM, that the nurse who provided care to all four (4) patients worked “Per Diem" for the Home Health Agency. The DON reported that this nurse also worked for the ALF, "she does have an official title” at the ALF, but the DON was not sure of the nurse's title at the ALF facility. 15. The Agency’s surveyor reviewed the personnel file of Respondent’s nurse who was also the ALF’s Director of Nursing on 05/26/11. The nurse, a Registered Nurse (“RN”), was also employed as the Director of Nursing for the ALF. The file also revealed that the Respondent paid the nurse a rate of $75 per visit. Review of the personnel files of three other RN's who worked per diem for the Respondent revealed that all three Page 6 of 13 nurses also received "Per Diem" pay. 16. In an interview conducted with the Respondent's Human Resource Manager (“HRM”), on 05/26/11 at 12:21 PM, the HRM reported that the Per Diem rate paid. by the Respondent depended on the type of visit and the day that each RN provided care to the patients. The HRM reported that the Per Diem rates ranged from $60 for a Start of Care visit on a holiday to $38 for a Discharge visit on a regular weekday. 17. The Agency’s surveyor asked, the Respondent’s HRM, during the interview, on 05/26/11 at 12:21 PM, to explain the reasons Respondent paid the ALF’s Director of Nursing, when acting as an RN for Respondent, $75 per visit. The HRM reported “that she believed that the nurse worked for a facility, but did not know the "dynamics" of the situation. ‘The HRM told the Agency’s surveyor that Respondent’s former HR Manager and DON hired the nurse who worked for both Respondent and for the ALF and set the pay rate. 18. The Agency’s surveyor'’s review, on 05/27/11, of the four (4) patients’ ALF clinical records revealed that three (3) ‘of the four (4) patients’ records lacked any documentation that the Respondent had encouraged the patients to exercise their rights and offered them a choice of home health agencies. The records failed to reveal any documentation ‘that the patients chose the Respondent to provide for their home health care Page 7 of 13 needs, . 19. In an interview with the Agency’s surveyor, conducted with Patient #1 on 05/27/11 at 9:44 AM, Patient #1 reported that she had received services from the Respondent, but reported that that she believed her insurance company had recommended the Respondent to provide care, The patient further reported, during the interview, on 05/27/11 at 9:44 AM, that the ALF’s Director of Nursing was the RN who provided care to the patient. 20. The Agency’s surveyor also conducted interviews with Patients #2°'and #4, on 05/27/11 with Patient #2 on 9:49 AM and Patient #4 on 05/27/11 at 9:50 AM. The Agency’s surveyor was told that neither patient was aware that they received home health services and did not know the nate of their home health agency. 21. . An interview was attempted, on 05/27/11 at 9:55 AM with Patient #3. However, the patient was severely cognitively impaired and was oriented to name only. 22. In an interview, conducted on 05/27/11 at 11:54 Am with the Respondent's DON, the Respondent’s DON provided the Agency’s surveyor with the referrals and physicians’ orders for the Start of Care for the patients. Review of the additional information at that time revealed the following: a. The documentation for Patient #1 included a referral form, dated 03/28/11 for the Start of Care of 03/29/11, Page 8 of 13 which was received from the ALF on 03/29/11 at 8:22 AM, as indicated by the facsimile transmittal information. The referral was completed on the Home Health Agency's own internal form and revealed the Respondent’s logo. The referral source was noted as the "pcp," Patient #1/s primary care provider, but failed to include the person's name who was taking the referral. The order for the Start of Care was dated, 03/28/11 and signed by the physician on 03/30/11. The nurse who signed as receiving the order for the Start of Care was the same RN who was also the ALF’s Director of Nursing. b. The documentation for Patient #2 included a physician's order, dated 12/29/10 for, "HHA to eval. and treat. Dx: Orthostatic B/P." This order, which was received from the ALF on 05/26/11 at 2:58 PM, as indicated by the facsimile transmittal information was not signed by a physician. The documentation included a second facsimile transmittal of the order, from the ALF, on 05/26/11 at 3:20 PM and 4:27 PM, that had included the same order, but this time the order included the physician's signature, but no date to indicate when the physician had signed the order. The nurse who signed as receiving the order was the same RN who was also the ALF’s Director of Nursing. c. The documentation for Patient #3 included a Page 9 of 13 referral form, dated 03/30/11 for the start of care of 03/31/11, which was received from the ALF's Administrator on 04/02/11 at 3:45 PM, as indicated by the facsimile transmittal information. There was no evidence of a referral source documented on the form. The referral was completed on the Respondent’ s own internal form and revealed the Respondent’s logo. There was no evidence of a physician's order for the Start of Care. d. The documentation for Patient #4 included a physician's order, dated, 03/11/11 for, "pT and OT (Physical Therapy and Occupational) eval (Evaluation) and treat. Dx Gait Ataxia." There was an order that was not signed by the physician. The nurse who signed as receiving the order was the same RN who is also the ALF’s Director of Nursing. “In an interview, conducted with the Respondent's DON on 05/27/11 at 11:54 AM, the DON acknowledged that the referral form was their own internal form and reported that the facility could have received the referrals from the patient's physician. The DON could not explain why the physician had used the Respondent's own internal form for the referrals. 23. The Respondent’s DON reported, during the interview, on 05/27/11 at 11:54 AM, that the Respondent had another form for physician's referrals and produced that form. The Page 10 of 13 | physician’s referral form required the referring physician to include less information. In a telephone interview, conducted with the Respondent's Administrator on 05/27/11 at approximately 12:00 PM, in the DON's presence, the Administrator reported that she could not provide an explanation how or why-a physician, or anyone else who provided referrals to the Respondent, would be able to obtain and use the Respondent’ s own internal form, instead of the physician's referral form that the Respondent had " provided to persons making referrals. 24. In a subsequent interview, conducted with the Respondent’ s ‘DON on 05/26/11 at 12:32 PM, the DON reported that the RN who was also the ALF’ s DON was the only nurse who worked for Respondent and also provided home health care through the Respondent to the patients in the ALF. 25. On 05/27/11 the Agency’s surveyor reviewed documentation for the RN who is’also the ALF’s Director of i Nursing. The RN's last earning statement from the Respondent, | . for the pay period that ended on 05/07/11, showed that the RN who is also the ALF’s Director of Nursing earned $825.00 from Respondent, before taxes, for 11 hours of work, at a rate of $75.00 per hour. Review of the earning statements for one of 1 the other three RN's whose personnel files were reviewed by the Agency's surveyor, for the same pay period, revealed that that nurse earned $424.00, before taxes, for 11 hours of work, at a Page 11 of 13 rate of $38.55 per hour. 26. The above allegations show that Respondent gave remuneration to a nurse who was on the staff of an assisted living facility and that Respondent received referrals from the assisted living facility, in violation of the prohibition of § 400.474(6) (e), Fla. Stat. WHEREFORE, the Agency intends to impose a fine in the amount of five thousand dollars ($5,000.00) for the cited violation, as mandated by.Section 400.474, Florida Statutes. NOTICE 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. oO ; _ All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to Agenoy Clerk, Agenoy 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 ...LN..AN_ADMISSION .OF.THE..FACTS ALLEGED IN THE COMPLAINT AND THE. .._. ENTRY OF A FINAL ORDER BY THE AGENCY. Page 12 of 13 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, 7003 1010 0001 3600 2596 to Charlene Welsh, Administrator, Comprehensive Home Care of Palm Beach, 110 Century Boulevard, Suite 102, West Palm Beach, Florida 33417, and by regular U.S. Mail to Roy J. Larson, Esq., as Registered Agent for Comprehensive Wellness Services, Inc., 1111.Brickell Avenue, Suite 1700, Miami FL 33131, on August 24, 2011. Copies furnished to: Arlene Mayo-Davis, FOM Assistant 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 13 of 13 BF COMPLETE THIS Si ‘nei = . ON ON DELIVERY SENDER: COMPL THIS SECTION Charlene Welsh, Comprehensive Home Care of Palm Beach 110 Century Boulevard, | Suite 102 ‘ West Palm Beach, Fl, 33417

Docket for Case No: 11-004431

Orders for Case No: 11-004431