A colleague of mine got a couple of phone calls from patients terrified they were going to be admitted to a nursing home.  Two men had come by with a three page list of questions and started asking very personal questions about whether or not they can get in a car, if they can go out to eat and how often their nurse visits.

My colleague reports in his email to me:

“They are not leaving cards or anything. One savvy patient finally got all their information and called us with it.”

and

“One patient was not home when they stopped at his house so they talked with and asked his neighbor questions.”

The men in question were employed by Jackson Dunham Sato & Associates. If you glance through the bio’s on the left sidebar, you will see that essentially all of the managers, partners and associates mostly come from one of two federal governing bodies – the OIG, and CMS (Medicare).  In fact, if you go to the top bar and click on careers, you will find that they are not interested in you if you are not:

• A current or former Office of Inspector General Auditor/Investigator with healthcare experience
• A current or former CMS employee who has been involved in program compliance/integrity oversight

At least you don’t have to worry about them poaching your employees.

I realize and you probably do, too, that all of this information is second and third hand.  In order to be responsible, I emailed each of the three senior partners and have not received a response.  The questions asked of them were:

1. Is this your usual policy regarding identification of your investigators on home visits?
2. Would it be possible to have your folks dress down; perhaps wear scrubs?
3. What explanation is given to the patients if they do not ask for identification?  Do the investigators allow them to make assumptions no matter how terrifying?
4. Do you understand that a patient fearful of nursing home placement might exaggerate their functional abilities?
5. Could you or do you leave some sort of documentation with the patients?  Patients are calling agencies who are unaware of your presence and cannot offer the patients any reassurance because they do not know who interrogated their patients.
6. Do you ever send clinicians out to the home to verify medication use and evaluate gait and balance?
7. Do you do a mental status exam on the patients?  Many patients with Alzheimer’s Dementia and other organic brain syndromes appear as right as rain the first couple of times you meet them.
8. How do you choose the providers you will be investigating?   Are they assigned to you by Health Integrity?  Do you have access to databases that you can mine for data?
9. How are you paid by Health Integrity?  Is your payment predicated in any way on recouped monies or arrests?

I have not gotten a response but Health Integrity, LLC confirms that Jackson Dunham, Sato and Associates are a ‘partner’ on their website.  Health Integrity, LLC is the Zone Program Integrity Contractor (ZPIC) for CMS Regions 2 and 4.  Combined, these two regions encompass  Alaska, Arizona, Colorado,  Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, New Mexico, Oklahoma,, North Dakota, Oregon, South Dakota, Texas, Utah, Washington, and Wyoming.

Regardless of an agency’s guilt or innocence, our elderly deserve to be treated with more respect than they have been shown by Jackson Dunham Sato and Associates.  I question the motives of a firm that resorts to intimidating elderly patients and possibly encouraging them to exaggerate their functional abilities in order to ‘prove’ that a patient is not homebound.  Are they genuinely concerned about the welfare of our elderly and protecting the trusts that fund Medicare or are they simply trying to satisfy a requirement for contract renewal, bonus pay or something else?

I can sit at my desk a thousand miles away from a patient and know whether or not their homebound status is questionable.  It is tedious to read every note, every MD clinic visit and OASIS assessment to look for discrepancies and the tell tale signs that the patient does not fit the description in the care plan and the visit notes.   It is not the most glamorous job in the world, I assure you but it can be done without instilling fear of unwanted nursing home placement in elderly people.  Even if a visit has to be made in order to make a final determination, it does not require rudeness or fear.  Even if the investigators are accompanied by a nurse from the agency, it is unlikely that a nurse would be able to influence the patient to lie.

The very best consultant and the very best lawyer cannot help you if you are determined to play outside of the conditions of participation and conditions for payment.  We’ll take you money and do our best. If it is a question of inadequate documentation versus fraud, we can generally help but there is not much we can do if you simply choose to sidestep the rules.

Nobody who works for Medicare or is contracted or subcontracted by Medicare seems to understand that good providers have even less tolerance for the fraudulent providers than they do.  If they would make just the tiniest effort to work with the majority of providers who are good, they might learn a thing or two and then it wouldn’t take years and hundreds of millions of Medicare dollars gone before they caught up with the truly bad players.  At that point, they could offer more frequent education to those providers who take compliance seriously.

If your patients have had visitors or if you have had experience with Jackson Dunham, Sato and Associates, please email me privately and let me know.  As always your comments are welcome below and if I get a response from Jackson Dunham, Sato and Associates, I will be sure to let you know.

One last thing….. if I ever hear of you intimidating a patient, watch out.  I am not nice when I hear of an elderly person treated with anything less than respect.