St. Anthony: Home health care CEO wants to clean up his industry

Andre Best, the nine-year owner of Best Home Care, wants to make a buck and a positive difference in an industry that is at the center of millions of dollars in fraud allegations.

And it may be best not to bet against this guy.

Best worked as a security guard at the Ford plant in St. Paul more than 20 years ago to help pay for his college education. He ended up managing a production line and completed law school in his off hours. Best, in a home health industry known for paper records, has deployed electronic records, ­verification and efficiency measures that he first learned about in law and business.

"I didn't have a background in the home health care industry, so I kind of made it up as I went along," said Best, CEO and owner of 330-employee Best Home Care of North St. Paul. "I do the research and try to do things a little better than they've been done. I'm trying to take the efficiencies and security measures you would get in a business like Ford, and build them into our system."

The Star Tribune reported in December that unscrupulous caregivers submit millions of dollars in fraudulent home care bills to the state every year. Only a fraction are ever prosecuted, or pay restitution.

Of the 425 home caregivers and agencies notified of wrongful billing practices since 2008, just one in four were ultimately convicted, according to a review of public documents by the Star Trib­une. Minnesota, once considered a leader in prevention of theft and fraud in the Medicaid program, now lags behind many comparable states in the number of cases investigated and the sums recovered for taxpayers.

Much of the home health care bill is paid by Medicaid, the federal-state funded program for the elderly indigent and the disabled who need care from a few hours a week to 24 hours a day.

Minnesota spent $600 million-plus last year. And it's estimated that up to 10 percent of that is fraudulent charges by owners or employees who overbill the state for "personal care attendant" time.

Best has contacted key state legislators about electronic-verification system software that he developed for his business with a software consultant. The system, an application for an iPhone or iPad, is an "easily auditable record of all services billed to the state, and produces a digital record of the care that patients receive and which can be compared to the patients' care plans," Best said.

And Best, an entrepreneur, has created a compliance-and-process improvement software subsidiary. And he'd be happy to sell his system to other operators.

"After having piloted this application in my own company, I am confident that it is ready to scale up to the entire Minnesota home care industry," he wrote.

Sen. Tony Lourey, a DFLer who is chairman of the budget division of the Senate Health and Human Services Committee, said he read, appreciated and forwarded Best's letter to the inspector general's office at the Department of Human Services (DHS). It is exploring proposed solutions from the industry and outsiders.

"We take this issue seriously," said Lourey. "I don't pick the vendors. But some of the recent attention to fraud has missed what we have done over the last two years."

The Legislature has funded the hiring of 40 DHS fraud investigators since 2013 in responses to complaints that, in part, preceded the Star ­Tribune stories.

The growth in the number of aging or frail Minnesotans who require help at home, state outlays for home care have more than quintupled in the last decade, to $618 million in 2013. Yet the number of referrals to the state's Medicaid anti-fraud enforcement unit has fallen by half since 2011, while notices of wrongful payments have stayed ­virtually flat.

Best said he was surprised by the antiquated record systems, often paper records, used by many home health care providers.

A track star at Oakdale's Tartan High School, Best paid his way through the University of St. Thomas by working at Ford, and caught the attention of management. He worked his way up to production supervisor, in charge of a line of 60 employees. He graduated from William Mitchell College of Law and thought he might become a corporate attorney.

Best, 40, worked for three years for the St. Paul city attorney's office and for a consumer agency.

He started his home health business in 2005 with $10,000 and no clients. His wife, a lawyer who now works for the Bush Foundation, had helped her brother start a similar business in Wisconsin. And Best, who long had been involved in senior and human rights issues, thought he could build a successful small business and also help needy people.

"You can make money in this business but you have to run it lean," Best said last week.

Last year, he posted revenue of more than $4 million. He employs 330 part-and full-time employees who serve several hundred clients. The state pays Best $16.63 an hour and Best pays up to $12.25 an hour to employees. He has five corporate employees, including himself.

Best, who pays himself about $100,000 a year and drives a nine-year-old Honda CR-V, said his goal is to build a successful, ethical business known for good service.

"Best is a great guy and a humble guy … and a substantial guy who does good work and who is smarter than he thinks he is," said John Penland, an assistant St. Paul city attorney who was Best's informal mentor a decade ago. "He went from labor to management to law to his own business. He's very smart and creative on technology and compliance. He's trying to stay in front of industry trends.

"And home health care is rampant with fraud. I trust him to deliver what he says he will do."

Neal St. Anthony • 612-673-7144 • neal.st.anthony@startribune.com