Acucare Health Strategies, Inc.: Outcomes: Regulatory Compliance


	For FY 2002 the OIG reported savings of over $426 million in audit disallowances, and $1.49 billion in investigation receivables. In addition, the OIG reported exclusions of 3448 individuals and entities for fraud or abuse of the federal health care programs and/or their beneficiaries, 517 convictions, and 236 civil actions.

Challenge: As a result of a patient complaint, a survey by the Health Care Financing Administration found nine (9) violations of the Medicare Conditions of Participation and decertified this national home health and hospice provider in a specific marketplace. This client was subsequently advised by the State in which it operates that its license was revoked. An internal audit revealed similar compliance issues in most of its locations.

Outcome:

Entered into an agreement to manage operations. Our team reported to Health System's CEO and the Board of Directors
Implemented a compliance plan to meet all regulatory guidelines
Wrote a plan of correction based on the survey findings that were acceptable to HCFA and the State Agency
Identified and corrected the organizational problems that led to non-compliance
Negotiated with HCFA to rescind the decertification in lieu of a 30 days penalty
Reduced the fines levied by HCFA and the State Agency by 81%
Created and implemented a "Synergy Program" to achieve a continuum of care for the Health System's patients by coordinating services between the hospitals, long term care facilities, and other entities owned and operated by the Health System
Managed a $51 million budget
Managed 19 offices, 2 inpatient facilities, one HME center and an infusion pharmacy
Realized cost savings of $4.4 million
Increased the conversion ratio by 17%, the length of stay by 14 days, and the market penetration by 29%
Increased staff productivity to 5.6 visits per day
Achieved a net income of 28.42%

Challenge: A national hospice provider was instructed by the Health Care Financing Administration to close down one of its agencies due to numerous violations of the Medicare Conditions of Participation. This client was also at risk in 4 other locations. The client also identified inadequate leadership, resulting in loss of market share and excessive staff turnover.

Outcome:

Entered into an agreement to manage operations. Our team reported to CEO and Board Chairman
Managed a $98 million budget with 32 offices nationwide
Realized $7.7 million in operations efficiency within 8 months
Increased the patient admission conversion ratio by 26% to 88%
Increased the length of stay by 24 days to 79 days and the market penetration by 26%
Implemented audit tools to ensure regulatory and clinical compliance, reduced claim denials, and improved accounts receivable collections

Challenge: A large health system discovered through a financial audit that $7.5 million in accounts receivable was at risk. Retained for accounts receivable management and recovery. Project consisted of clinical audit and billing review for accurate claim submission to Medicare.

Outcome:

Uncovered serious regulatory and compliance violations causing us to invoke attorney client privileges and retain outside counsel to assist client with potential fraud and abuse issues
Utilized audit outcome to create a staff education program regarding patient care issues, compliance, fraud and abuse, and documentation
Audit outcome precipitated a process redesign and the re-engineering of operations
Launched a new information system to support the agency's new processes
Collected $57.8 million dollars
Reduced Day Sales Outstanding (DSO) from over 270 days to 55 days

Challenge: Medical practice considering acquisition of another group and the startup of an outpatient surgery center.

Outcome:

Assisted the practice in acquiring the smaller group and achieving economies of scale
Implemented compliance measures to overcome potential regulatory violations with self-referral to the outpatient surgery center
Advised client on self-referring to their physical therapy practice
Implemented operations and billing efficiencies realizing annual savings of $2.3 million
Recovered $900,000 of uncollected receivables and reduced aging to 62 days

Challenge: A financially strapped internal medicine practice, with physicians at times declining their salaries, wanted to practice holistic medicine without the pressures of seeing more patients to maintain the financial viability of the organization. Patient dissatisfaction was growing due to long patient wait times to see a physician. A lack of technology existed within the office hindering the facilitation of workflow. A lack of knowledge also existed concerning HIPAA's new regulations regarding privacy and security.

Outcome:

Created new service lines to increase revenue while allowing the physicians to continue to practice as they saw fit, despite the pressures of declining insurance reimbursement
Created professional development and training plans
Redesigned the charge master
Renegotiated managed care and service contracts
Redesigned scheduling process and implemented technology for scheduling, patient reminders, and actual visit documentation in order to reduce wait time and actual time needed for each visit
Conducted patient satisfaction surveys and implemented many suggestions
Oriented staff and physicians to new law and regulatory requirements
Redesigned and implemented process changes to meet regulatory requirements

Challenge: Through an internal audit, a national healthcare provider identified falsification of clinical records by a contractor.

Outcome:

Reviewed clinical records with a focus on patients' signature and visits time verification to payroll data
Verified all contractors' records relevant to the services provided and the involved staff
Audited the contractors' payroll and billing practices from the initial date of the agreement to determine the scope of the problem
Assisted legal counsel and the client to self report


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