Caring Hearts Personal Home Services is an organization in Kansas which offers nursing care and physical therapy to Medicare patients who, for health reasons, are unable to leave their homes and are considered to be “homebound.” Though Caring Hearts has been a huge help to many in its community, the organization recently found itself at odds with the federal government.
Since the organization caters to Medicare patients, it is subject to oversight from the Centers for Medicare and Medicaid Services (CMS). A recent audit by CMS led to claims that several of Caring Hearts’ patients did not meet the qualifications necessary to be labeled as “homebound.”
As a result, CMS was demanding repayment from Caring Hearts for all services that CMS deemed “unreasonable and unnecessary.” CMS asserted that Caring Hearts rendered $800,000 worth of services that did not meet the standards necessary in order to be covered by Medicare. However, as it turned out, CMS was unfamiliar with its own regulations.
One of the cases in question involved an 85-year old who weighed more than 350 pounds and who was, more or less, confined to a wheelchair. Currently, CMS regulations specify “homebound” patients as those who have a “normal inability to leave home,” while “leaving home must require a considerable and taxing effort.” According to the CMS, this wheelchair-bound patient did not meet these qualifications.
However, in 2008, when the care was given to this patient, “homebound” was defined by CMS to mean any patient who had a “condition due to an illness or injury that restricts their ability to leave the place of residence except with the aid of: supportive devices such as crutches, canes, wheelchairs, or walkers.”
Clearly, given the circumstances surrounding the wheelchair-bound patient, the care provided by Caring Hearts in 2008 met all the necessary standards in place at the time. However, CMS was so out of touch with its own regulations, it was not aware of the rule change that took place between 2008 and the present day.
“What happens if we reach the point where even these legislating agencies don’t know what their own ‘law’ is?” Judge Neil Gorsuch asked after the Tenth U.S. Circuit Court of Appeals ruled unanimously in favor of Caring Hearts.
The court held that CMS “seems unable to keep pace with its own frenetic lawmaking,” and that, “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.”
CMS’ inability to keep track of its own rules is not something unique to their agency alone. In fact, with over 175,000 pages of federal regulations in place as of 2014, it has become impossible for anyone to keep track of all the federal rules currently in place.
When the ever-growing bureaucracy of the federal government prevents businesses from being able to help their consumers, especially when the commodity in question is health care, there is a real problem with our regulatory system. Luckily for Caring Hearts, this story had a happy ending. But many other businesses are not so lucky.