In the Courts: CMS Relied on Incorrect Regulations in Finding That Home Care Patients Did Not Qualify

The U.S. Court of Appeals for the 10th Circuit has found that the Centers for Medicare and Medicaid Services (CMS) inappropriately relied on current regulations, rather than those that were in effect at the time services were provided, when determining that a home care agency provided services to a number of patients who did not qualify because they were not homebound and provided services that were not reasonable and necessary. The appeals court found in favor of the home care agency, remanding the case to the district court.

The agency provided skilled nursing and physical therapy services to "homebound" Medicare patients. During an audit, CMS determined that services were provided to a number of patients who did not qualify for services because they were not homebound and that services provided to some other patients were not "reasonable and necessary." CMS ordered the agency to repay...