Home health agency fined more than $123,000 for poor quality care

A home health care agency with a history of regulatory violations was fined $123,219 by the federal government earlier this year, the Iowa Department of Inspections and Appeals said this week.

The fine, imposed early in 2022, had not been previously disclosed.

The civil penalty is tied to a Dec. 7, 2021, visit by DIA inspectors who were responding to a complaint against Iowa Home Care of Ottumwa. The state agency cited the business for 17 regulatory violations — an extraordinarily high number of violations for a home health provider.

Among the alleged violations: failure to adequately review patients’ medications in seven of the 10 cases that were examined; failure to adequately assess patient needs in five of the 11 cases reviewed by inspectors; and, in five out of 14 cases reviewed, failure to report to a physician any changes in a patient’s needs.

One of the violations stemmed from a pharmacist’s complaint that the agency was attempting have a teen-age patient and her parents learn how to self-administer an injectable drug used to treat rickets, a disease that results in a softening of the bones. The patient’s physician had twice warned the agency that the drug should only be administered by a health care professional in accordance with the manufacturer’s guidance.

Inspectors also noted that although the federal government had recently barred the agency from using its own staff to train workers or administer competency tests, it had ignored that directive and trained both of the newly hired workers whose files were reviewed by inspectors.

When inspectors asked the agency’s administrator about the violations, she indicated she was aware of the two-year ban on training and testing new workers but felt that since one of the new hires was certified as a nurse aide, “it would be OK” to do the training and testing anyway.

In January of this year, DIA conducted a revisit and cited the business for an additional 10 violations, but determined the business was in substantial compliance with federal guidelines. The federal Centers for Medicare and Medicaid Services subsequently imposed a $3,213 daily civil monetary penalty against the business for each of the 59 days the business was deemed to be out of compliance.

The daily fines totaled $189,567. Because Iowa Home Care waived its right to appeal the penalty, CMS automatically reduced the fine by 35% to $123,219.

CMS has given Iowa Home Care of Ottumwa one of the lowest quality rankings of any home health care agency in Iowa: one and one-half stars on a five-star scale.

At the time of the January 2022 inspection, the business provided care for 190 Iowans. Inspectors reported that the agency’s chief of organizational performance said the agency had stopped “admitting new patients due to the fines and being unsure if the office would be kept open. The agency was not going to hire any new employees due to the issue of fines.”

In August, inspectors returned and cited the agency for three additional violations, including failure to follow a patient’s plan of care by not providing the physician-recommended number of home-care visits.

In addition to the Ottumwa office, Iowa Home Care has locations in Knoxville, Webster City, Boone, Marshalltown and West Des Moines. The company was founded in 2004 and is run by Kimberly A. Weber, a registered nurse who founded Iowa Home Care LLC and serves as its registered agent.

Stefanie Bond, spokeswoman for DIA, said the fine imposed against Iowa Home Care is, to DIA’s knowledge, the only federal fine levied against an Iowa home health care agency in 2022.

Earlier this year, it was revealed that a federal judge upheld a fine of $414,000 against another Iowa home-care provider, Sioux City’s Mercy Home Care. That fine was originally imposed in 2016, but the lengthy appeal process and subsequent delays in publishing a decision resulted in the matter becoming public in early 2022.

Mercy Home Care had challenged the fine, calling it unreasonable. In a strongly worded ruling, Administrative Law Judge Leslie C. Rogall stated that, if anything, the penalty was “unreasonably low.”