[Updated] CMS ‘Confused About Its Own Law’ in $800,000 Home Health Case

The Centers for Medicare & Medicaid Services (CMS) flubbed an $800,000 case against a home health agency located in Kansas City, Kansas, a district appeals court found. The court overturned CMS’ recoupment of $800,000 from the agency, Caring Hearts Personal Home Services, Inc.

While CMS ordered Caring Hearts to repay $800,000, CMS was ultimately found to be “struggling to keep up with the furious pace of its own rule making,” according local judges in the U.S. Court of Appeals 10th Circuit. The appeals court ruled that CMS applied the wrong laws against Caring Hearts for allegedly billing Medicare for services to patients who were not qualified to receive home health care.**

CMS based its case against Caring Hearts on a rule that did not exist at the time the services were provided, judges ruled.

“Medicare is, to say the least, a complicated program,” the district court opinion states. “But how did CMS wind up confused about its own law?”

Part of the problem lies with a lack of definition for the necessity of home care, the court found.

“Congress hasn’t exactly been clear about who qualifies as homebound or what services qualify as ‘reasonable and necessary,’” the documents read. …“The trouble is, in reaching its conclusions CMS applied the wrong law.”

Instead of applying the laws that were on the books during 2008, when Caring Hearts performed its services, CMS punished the home health provider for laws that didn’t come into effect until years later. Who qualifies for homebound services today is different than the regulations in effect in 2008, the court ruled.

As a result, Caring Hearts is able to make its case that the services it provided during that time were consistent with the law at the time.

“An agency decision that loses track of its own controlling regulations and applies the wrong rules in order to penalize private citizens can never stand,” the opinion concludes.

Written by Amy Baxter

**Editor’s note: This article has been updated from an earlier version that suggested Caring Hearts Personal Home Services, Inc. had been charged with Medicare fraud.