New Alliance Ceo Sheets Puts Spotlight On Home Health Fraud, Waste And Abuse 

Jennifer Sheets, the new CEO of the National Alliance for Care at Home (the Alliance), is focusing “first and foremost” on home health program integrity.

Dr. Mehmet Oz, the administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), has placed a spotlight on fraud, waste and abuse in the home health industry, and the topic is now one of the most important issues for the Alliance, Sheets told Home Health Care News. 

“From my perspective, there is absolutely no room for fraud, waste and abuse at home,” Sheets said. “We certainly support efforts to root out bad actors who threaten the integrity of our health care system.”

Sheets, who replaced Dr. Steve Landers as the Alliance’s CEO in February, has spoken with Oz directly about home health program integrity. 

“Over and over again in these meetings, he said, ‘I need to know that the industry is … helping me in rooting out these issues,’” she said. “He brought up some other scenarios where he had to paint with a very broad brush, because there was no one helping him figure out how to determine who’s a bad actor and how he determines a good actor. As the Alliance, one of the main reasons for meeting with him is saying, ‘Look, as an industry, we are right there with you. We agree there’s no place for fraud.’ Now, we also don’t want that broad brush, and we have to make sure that we are impacting bad providers without hurting the good ones and the compliant ones, which is most of them.”

The Alliance has encouraged CMS to create a task force dedicated to rooting out home health fraud, and offered to take part in the initiative, Sheets said. The home health industry must prepare for increased program integrity, she said, which will focus on situations where care is not being delivered – not billing errors.

Top challenges and motivations

In addition to focusing on program integrity, Sheets has identified Medicare home health rates and workforce challenges as her other top priorities for the Alliance.

Years of Medicare home health payment cuts, paired with persistent inflation and a nationwide health care worker crisis, have made operations increasingly difficult for home health providers.

“We cannot tolerate any future pay cuts, and although there was definitely a lot of mitigation from proposed rule to final rule, any cut in home care services is not okay, and it impacts access,” Sheets said. “We’ve seen 25% of agencies close already, and that’s before this most recent cut.”

Medicare cuts have exacerbated the workforce crisis, she said, so the Alliance is advocating for payment policies that support providers’ ability to recruit and retain nurses, aides and therapists. But the Alliance is going beyond payment policy to support a more sustainable workforce landscape, looking to immigration reform and vocational school programs, Sheets said. 

Sheets started her career as an intensive care unit (ICU) nurse and has held executive roles at a slew of home-based care providers, including Interim HealthCare, Bayada Home Health Care, Gentiva Health Services and Kindred Healthcare. However, the most meaningful preparation for her new role as the Alliance’s CEO came from serving as her mother’s full-time caregiver for two years.

“I felt the physical exhaustion,” she said. “I felt the confusion, the fragmentation, the anger, quite frankly, of trying to coordinate that care. I remember thinking, if somebody like me can’t figure out how to coordinate care, and I’ve been doing this my entire career, … how in the world is the everyday family member supposed to have a clue. So that really fueled me to think about … how we deliver care better.”

For Sheets, long-term success for the Alliance would include having reimbursement rates that exceed the cost of care, program integrity that roots out fraudulent providers without impacting compliant providers and regulatory clarity.

Additionally, she aims to continually elevate home-based care, with models such as value-based care and palliative medicine integration to help transition patients into hospice care sooner. The Alliance is working to support more research on home-based care. Developing independent, peer-reviewed data for the home-based care and hospice industries will help advocate for the industry as a whole, she said.

“Our strength is in representing that full continuum together – we are stronger when hospice and home health and palliative care kind of speak in one voice,” Sheets said. “The thing that we know that absolutely does not work is when decision makers see us not unified, and we have to be able to have that collective voice. … The time for making incremental gains is really behind us.”

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