The document discusses several cases of home health workers stealing the powerful opioid painkiller OxyContin from patients. It provides tips for home health agencies to prevent prescription drug theft among employees and protect patients, such as carefully tracking OxyContin supplies, encouraging employees to report suspicions, and conducting thorough background checks and drug testing. The article warns agencies could face legal and financial consequences if employees steal drugs. Separately, it reports that a government committee has approved 15 recommended changes to reduce the burden of the OASIS assessment tool.

1. u 6 tips to prevent trouble with OxyContin ............3
u CMS-picked committee advances
15 recommended changes to OASIS...................4
Visions of a new, less-burdensome OASIS are one step closer
to materializing after a recent meeting of CMS's regulatory
reform committee.
u List of reform committee's
15 OASIS recommendations ...........................5
u The trade: OASIS changes
for support of quality indicators .....................6
u Sample of ad comparing quality indicators
for nursing homes; HHAs next .......................7
u House & Senate bills would
loosen homebound definitions ............................6
When lawmakers finally get around to passing Medicare
provider relief legislation, it could include an important change
in the homebound definition to allow non-medical absences
from home.
u Benchmark of the Week #46
Intense focus on weight key to keeping
CHF patient rehospitalizations in check..............9
What's Adventist Home Health's secret for maintaining
rehospitalization rates at less than one third the national average
for congestive heart failure patients?
u Chart: CHF patient rehospitalizations
double the norm .............................................10
u CHF patients pay less, stay longer...............11
u PRRB rules agencies' legal &
marketing costs not reimbursable.....................11
Legal fees incurred by a Denver home health agency in a court
battle over who controlled the now-defunct HHA shouldn't have
been charged to Medicare, the Provider Reimbursement Review
Board has ruled.
u Home care market notes.....................................12
3M names the new boss of its home care systems unit. Amedisys
hires a new accounting firm. VITAS and Option Care expand.
And Star says "not so fast" to NASDAQ delisting efforts.
Charges against home care
employees spotlight danger
of powerful drug OxyContin
An HME company's regional
manager starts making unscheduled
stops at patients' homes. A home health
agency's director of nursing falls asleep
in the car on a trip to an off-site
conference.
Either incident could have an
innocent explanation. Regrettably,
however, they both were the first
warning signs that these companies'
high-ranking employees allegedly were
stealing the powerful opiate OxyContin
from patients' homes.
Brendan Murphy, a delivery
technician and regional manager for
Merriam Graves Medical Equipment, in
Winooski, Vt., entered a "not guilty"
plea last month on seven counts of
obtaining a regulated drug by deceit and
six counts of exploitation of a disabled
adult. He faces up to 23 years in jail and
$95,000 in fines if convicted on all
counts.
The Vermont attorney general's
office contends that complaints were
received about the 36-year-old man
from no fewer than eight families. A
five-year employee of Merriam Graves
who supervised nine other workers,
Murphy allegedly was caught on tape
stealing drugs after police set up a video
sting operation.
But Murphy is not the only home
care worker to fall prey recently to the
addictive qualities of OxyContin.
Just this week Mary Jo Williams, a
former home health aide at Home
Health United, Portage, Wis., pled "not
guilty" to charges that she stole a
patient's OxyContin supply and
substituted the steroid Prednisone. The
May 31, 2002 l Volume XXVII No. 21

2. www.myhomehealth.com
2 t
May 31, 2002
patient, who was paralyzed from the neck down due to a motorcycle
accident, reportedly
patient, who was paralyzed from the neck down
due to a motorcycle accident, reportedly
experienced seizures and lost almost 40 pounds
before the medication switch was detected.
Williams, 38, was diagnosed with Lupus in
1996 and prescribed both Percoset and Vicodin,
according to charging documents. She allegedly
was suffering from withdrawal when she stole 80
to 100 OxyContin pills over a period of several
days.
Following patient complaints, Home Health
United interviewed Williams, the patient and his
family, as well as all other staff who had been in
the home, Tom Brown, the agency's president,
tells …hhl. Before Williams' arraignment, United
employees informed all of her patients about the
problem and notified them that she had been
terminated. The company also is beefing up its
medications safety training and regularly
instructing its nurses to talk about preventing
other visitors to the home from accessing
medications, Brown says.
If convicted on separate counts of theft and
reckless endangerment, Williams could face up to
11 ½ years in prison. She's also charged with
stealing prescriptions of Percocet and Roxocet,
allegedly replacing another patient's pills with
Tylenol.
...home health line Subscriber Services
We want to help you in any way possible.
Here's how to reach us:
OUR FAX NUMBER: 301/816-8945.
STAFF:
Group Publisher: Tonya Nevin, 301/287-2454
(tnevin@ucg.com)
Publisher: Jason Huffman, 301/287-2476
(jhuffman@ucg.com)
Senior Editor: Burt Schorr, 301/287-2258
(bschorr@ucg.com)
Associate Editor: Linda Busche, 301/287-2442
(lbusche@ucg.com)
Associate Editor: Elizabeth Orr, 301/287-2551
(eorr@ucg.com)
Associate Editor: Marisa Torrieri, 301/287-2305
(mtorrieri@ucg.com)
Marketing Specialist: Stu Simon, 301/287-2289
(ssimon@ucg.com)
Advertising Coordinator: Christian Deck, 301/287-2662
(cdeck@ucg.com)
SUBSCRIPTIONS: Direct questions about newsletter
delivery and account status to the Home Health Group
at 1-888/293-9383 or e-mail to: hhlcustomer@ucg.com
Price: $437/year.
ADVERTISING: To inquire about advertising in ...hhl,
call Ad Coordinator Christian Deck, 301/287-2662.
REPRINTS: To receive photocopying permission, call
1-888/293-9383 and ask about our copyright waiver,
multiple copy and site license programs.
Or e-mail: customer@ucg.com
...home health line ISSN 1078-2389 is published weekly
(except for Memorial Day, Labor Day, Thanksgiving and
Christmas) by UCG, 11300 Rockville Pike #1100,
Rockville MD 20852-3030 (www.ucg.com). Periodicals
postage paid at Rockville, MD, and at additional mailing
offices. Postmaster send address changes to ...home
health line, 11300 Rockville Pike #1100, Rockville MD
20852-3000. Copyright 2001.
Register today at WWW.MYHOMEHEALTH.COM to get
access to your …home health line newsletter days
before the print publication arrives in your mailbox. Plus,
you get tons of other features, like continuously updated
news postings; a new action item each morning to help
you run your home care operation more efficiently; a
calendar of important home care events and much,
much more.
If you’re having trouble getting access to your Internet
edition of …home health line, send an e-mail to
hhlcustomer@ucg.com to get your password now.
INTERNET FORUM: To join ...home health line’s free
Internet discussion group for all home health agencies,
go to WWW.MYHOMEHEALTH.COM, click on “Idea
Exchange” and follow the simple instructions. You can
start talking to other home care execs across the country
today.
CONFERENCES: ...home health line holds seminars to
help you meet professional challenges. For program
schedules, call 800/929-4824, ext. 2684; e-mail address:
conference@ucg.com
COPYRIGHT WARNING: Copyright violations will be
prosecuted. ...home health line shares 50% of the net
proceeds of settlements or jury awards with individuals
who provide essential evidence of illegal photocopying
or electronic redistribution. To report violations contact:
Roger Klein Esq., Howrey & Simon, 1299 Pennsylvania
Ave. N.W., Washington, D.C., 20004-2402. Confidential
line: 202/383-6846.

3. www.myhomehealth.com
t 3
May 31, 2002
Neither attorneys for Murphy and Williams
could be reached for comment at press time.
A heroin-like high; related crimes up 75%
Given the largely independent nature of your
field staff, as a home care company you're already
more susceptible to the danger of employees
stealing and using patients' prescription drugs. But
your staff has never confronted anything as
addictive and readily available as OxyContin.
Even if you don't provide the drug, there's a
good chance your home care employees will come
across it in a patient's home.
OxyContin is the more commonly known
brand name for the narcotic oxycodone,
manufactured by Purdu Pharma, Stamford, Conn.
Since it was first introduced in 1996,
prescriptions have increased by 1,800%, the U.S.
Drug Enforcement Administration reports. There
were 5.8 million prescriptions dispensed in 2000.
It's rapidly becoming a $1-billion-a-year drug, the
DEA says.
In the home health arena, the drug is most
commonly provided in tablet form to terminal
patients or those with severe chronic pain.
OxyContin's advantage over other opiates is its
time-release formula, which provides long-lasting
relief from pain. Unlike some other opiates, the
drug allows users to remain awake and alert.
To sidestep the time-release factor and
achieve what they describe as a heroin-like high,
addicts often crush the tablets and snort the drug.
6 tips to prevent trouble with OxyContin
Have your nurses update your patients' medication records every time they visit. Have them count
the pills and ask the patient how many have been taken.
Those are few of the precautions Sue Crabtree, branch manager at Jonesville, Va.-based
Independent Home Health Care takes to make sure her patients are taking their prescription drugs as
scheduled and their drugs are not being lifted.
As a home care company, you're particularly susceptible to prescription-drug theft. And the
growing pervasiveness of OxyContin doesn't help [See related article, p.1]. Other techniques to protect
your agency:
n Track your OxyContin stock carefully. A perpetual inventory is one way to do this, says
Donna Morscheiser, pharmacist director, Family Pharmacy & HME, Peru, Ill. Family Pharmacy keeps
the drug locked up and records the number of pills dispensed and the number left every time it's
prescribed.
n Encourage employees to report their suspicions. "Employees always know what's going on,"
says Washington, D.C. attorney Jim Pyles, attorney for the American Assn. for Homecare. To make
sure an employee who suspects a problem doesn't keep mum, Pyles recommends you implement a
compliance plan that includes a mechanism for anonymous reporting, such as a toll-free number. The
policy should also stress that people who report problems won't be punished, Pyles says.
n Don't pass the problem along. It can be painful to bring in law enforcement officials, so
providers might opt to simply dismiss the employee. But that's the worst thing you can do, says John
Burke, vice president of the National Association of Drug Diversion Investigators (NADDI) and
commander of the Warren County (Ohio) Drug Task Force. Not only does it fail to address the staffer's
problem, but it often violates state regulations that require you to report missing narcotics, Burke says.
n Start with a thorough criminal background check on all new hires. Following the arrest of
an HME regional manager for allegedly stealing OxyContin, Merriam Graves Medical Equipment
recently expanded its background checks to cover surrounding states, Jim Barker, spokesman for the
Winooski, Vt., company, says in a written statement.
n Make sure your drug testing firm can detect opiates. Not all do, believe it or not, says drug-
testing specialist Tom Mieczkowski, a professor of criminology at the University of South Florida. If
opiates are detected, another test, called the GC/MS, is necessary to determine exactly which opiates
are present. This test typically costs $75-100 per person, Mieczkowski says. u

4. www.myhomehealth.com
4 t
May 31, 2002
As of summer 2001, the DEA reports:
• 400 deaths nationwide associated with
OxyContin;
• 700 pharmacies robbed for OxyContin;
Crimes associated with OxyContin increased by
75% since 1999 Misuse is most prevalent in the
Appalachian and New England states, the DEA
reports, although reports of OxyContin-related
crimes are up throughout the country.
Typically, addicts either alter prescriptions or
"doctor shop," visiting doctor's offices and
feigning injury until the drug is prescribed,
experts say. It also can be purchased on the street,
where a typical price is about $1/milligram, or $20
for a 20/milligram pill, the National
Clearinghouse for Alcohol and Drug Information
says. OxyContin comes in 10-, 40-, 60-, and 80-
milligram strengths.
Purdue Pharma has taken "virtually every step
that anyone can think of" to try to thwart
addiction, spokesperson Tim Bannon tells …hhl.
While the manufacturer has no special tactics
for home health or healthcare professionals, it has
taken measures to make prescription pads tamper
proof, educate physicians and law enforcement on
prescription drug abuse, and provide special
brochures for pharmacies detailing the signs of a
drug abuser.
Lots of unexpected time off was a clue
One of the first publicized incidents of a home
health employee stealing OxyContin occurred in
1999 -- three years after it was introduced.
A Sauk County, Wis., judge ordered 180 days
in jail and 36 months probation for Michele
Stanton, the former director of nursing at a home
health agency in Lancaster, Wis. The 48-year-old,
who once supervised three nurses, pled guilty to a
charge of narcotic drugs possession.
Like HME manager Murphy, Stanton was
caught after patients reported drugs missing from
their home, says the owner of the Wisconsin
HHA, who asked to remain anonymous.
The owner, who inherited Stanton as an
employee when she acquired the agency, says she
suspected there was a problem when her director
of nursing began to take a lot of unexpected time
off. She discovered Stanton already was on
probation for stealing drugs from a hospital that
previously employed her.
The day Stanton fell asleep while riding in a
car on the way to a conference, the owner says she
searched her vehicle and found alcohol. The next
day, employees at another branch office called to
let the owner know that one of Stanton's patients
had called to report missing painkillers.
Stanton could not be located at press time for
comment.
Consequences go beyond embarrassment
Don't want your home-care company
spotlighted by the media because one of your
employees stole pain-killing drugs from a
chronically ill patient?
Bad press may be the least of your concerns,
warns attorney Tom Antone, Mintz Levin Cohn
Ferris Glovsky Popeo, Washington, D.C.
In one recent case where a nurse substituted a
grape drink for a patient's morphine, the home
health agency's insurer settled a civil suit with the
family for $1 million […hhl, 3/29/02].
Plaintiffs like to go after employers "because
that's where the deep pockets are," Antone says. A
criminal case would require more proof, but it is a
possibility if an agency "recklessly" employed
someone known to have a problem with drugs, he
adds.
Another possible consequence to a home
health agency might be having its Medicare
participation revoked, Washington, D.C., attorney
Jim Pyles, with the American Assn. for Homecare,
warns.
The conditions for participation require that
narcotics are properly handled and stored, he
notes. In the past, agencies have been excluded
from Medicare for transgressions such as allowing
nurses to store drugs in their cars overnight.
u -- Special contribution by Elizabeth Orr,
editor, HME Answer Book [eorr@ucg.com]
Non-medicare requirement tabled for later
HHS-picked committee
advances 15 recommended
changes to OASIS
Visions of a new, less-burdensome OASIS are
one step closer to materializing following a recent
meeting of the Department of Health and Human