St. Anthony: Insider looks to reduce fraud in home health care

Andre Best, the 10-year owner of Best Home Care, believes he's developed at least a partial solution to fraudulent employees and employers who cost Minnesota taxpayers millions annually in overcharges for care not delivered to elderly indigent and disabled clients covered by state-federally funded Medicaid.

Best, whom I profiled in February 2015, was disappointed last year when Minnesota did not mandate an electronic-verification system that would make it harder to inflate hourly billings in an industry in which Minnesota pays providers more than $600 million annually.

The Minnesota Department of Human Services (DHS), responding to 2015 legislation, recently rolled out a safeguard system that involves random phone calls to ensure a client and provider are together when scheduled.

Best believes that's not good enough. And DHS concedes it's only "a small first step" to guarantee compliance. The current system relies heavily on a paper process through which personal care attendants (PCA) record the number of hours worked, and client recipients or representatives sign the form to verify reported hours.

"We will be the first to admit that the new statutory requirement for random calls to the PCA and the PCA care recipient is an inadequate approach to controlling the fraud in the personal care assistant industry," DHS Inspector General Jerry Kerber said in a written response to questions.

"The more exciting component of that legislation is the encouragement to providers to propose an alternative, technology-driven approach that will meet the same expectations of verifying that the PCA and the recipient are at least together. It's a bonus if the approach can go the next step and verify that services were provided."

Best said he has invested $50,000 to develop compliance software through his compliance-consulting firm, PCA Partners. And DHS, after some modifications, has granted Best a waiver to use the system, although it is not endorsing it. It also has granted several waivers to other operators.

Best said he's going to provide the software free to 25 or so competitors to prove it works.

"It's not fool proof and it's just one thing, but it's a pretty good solution," Best said last week. "We're just trying to give providers a solution and improve the industry. I hope it works for the other agencies."

Best said he doesn't intend to profit from the technology. He would transfer it at no cost, perhaps eventually through an industry-funded nonprofit or public benefit corporation that would manage and maintain it.

The current system allows PCAs and employers to rook taxpayers by generating false documentation showing that they were present to provide a service when they were not. Sometimes the recipients sign inaccurate or even blank time sheets because they are vulnerable to coercion. Sometimes the recipient or the recipient's representative collude with the personal attendant, receiving payment for collusion, according to state investigators.

Best's system doesn't just replace the paper with an automated documentation. It uses an iPhone into which the attendant punches in, randomly requests a selfie of the attendant and the client, and also uses GPS to document their location.

The 2015 legislation starts with the random phone calls and ends with encouraging providers such as Best to develop and propose an alternative, technology-driven approach that will meet the same expectations of verifying that the PCA and the recipient are at least together.

DHS officials also note that the department has stepped up investigations over the last two years that have resulted in several million dollars in annual recoveries from providers who bilked the state.

Best is also betting that this innovation helps build his business.

He said Best Health Care posted a 20 percent revenue increase last year to about $5 million.

"We're reinvesting most of the cash flow in the business to develop a better practice," Best said. "We invest in technology and people."

Best employs about 275 permanent employees who serve 250 clients. The state pays Best $17.08 per hour and Best pays employees up to $12.50 an hour, plus paid time off and free preventive health care. Best said he pays himself about $100,000 a year.

Best, 41, paid his way through the University of St. Thomas, working at the former Ford plant, first as a line worker, then promoted to production supervisor. He graduated from what is now Mitchell Hamline College of Law, and moved to the St. Paul city attorney's office.

Best, who had done some advocacy work for seniors as a business owner and lawyer, started Best Health Care in 2005.

"I like this business because it's my business," he said. "And I want to make it better. And I like to help people, clients and employees. I pay more than the minimum required under the union labor contract. And I believe electronic software is how the state will eliminate fraud induced by a small percentage of home health care agencies, workers and recipients."

Neal St. Anthony has been a Star Tribune business columnist and reporter since 1984. He can be contacted at neal.st.anthony@startribune.com.