Despite ‘fraudulent practices’ finding, no state probe of home health agency

State regulators say they have never inspected and are not investigating a home health agency alleged to have falsified records, billed for services never delivered and used an unlicensed nurse.

State records show that Compassion North America, a home health provider based in Cedar Rapids, was incorporated in 2017 with M’balu Madlene Kebbie, a registered nurse, as its director, but was not licensed by the Iowa Department of Inspections, Appeals and Licensing until September 2024.

When asked about that, department spokeswoman Diane McCool said it’s possible the company was not providing any medical services in Iowa prior to being licensed last summer.

However, records from the Iowa Board of Nursing, which is administered by DIAL, and sworn testimony from a state health investigator at a hearing overseen by DIAL, indicate the company has been providing medical care for clients at least since June 2022.

In addition, the company’s archived website indicates that in February 2021, Compassion North America was offering clients and patients a range of “nursing plans” and “medical intervention” to meet their care needs.

McCool said DIAL has never inspected Compassion North America due to it being inspected and accredited by a private organization, the Accreditation Commission for Health Care. She said DIAL does not have copies of the organization’s inspection findings, and the ACHC did not respond to the Iowa Capital Dispatch’s calls and emails on the matter.

Compassion North America’s CEO, Joseph Lemor, who is married to Kebbie, referred questions on his company’s licensing and accreditation to attorney David L. Brown, who indicated he had no information to share on those specific issues.

Lemor has said the state is engaged in a “witch hunt” with regard to Kebbie. “We did not do anything improper,” he told the Iowa Capital Dispatch earlier this month. “We have nothing to hide.”

DIAL: No investigation of home health agency

McCool said DIAL, as Iowa’s regulator of home health agencies, is not currently investigating Compassion North America — despite the findings of the Board of Nursing or its investigator that the company falsified records, billed for services that appear to have never been delivered, and employed an unlicensed nurse to provide patient care.

Those allegations surfaced recently at a Board of Nursing disciplinary hearing for Kebbie.

In September 2022, the board alleges, it received a complaint from a patient, “G.F.,” who alleged Compassion had assigned unlicensed staff to perform skilled nursing care tasks, and that the staff failed to complete documentation of the care provided in his home.

Compassion North America was approved by Iowa Medicaid’s managed care organization, Amerigroup, to provide care for G.F. from June 29, 2022, through Aug. 29, 2022 — during which time the company was not licensed as a home health provider, according to DIAL.

A state investigator allegedly reviewed the work schedules of Compassion employees, which reportedly showed the company was not actually providing 24/7 care to G.F. as ordered. The caregivers listed on the work schedule allegedly included four individuals, only two of whom — Kebbie and licensed practical nurse Elizabeth Smith — were licensed nurses.

However, Smith’s nursing license had expired in January 2021 and was not reactivated until 18 months later, on July 6, 2022.

The state investigator reviewed thousands of pages of records subpoenaed from Compassion, the board says, and concluded Smith was the only nurse to document any nursing care for G.F. from June 29, 2022, through July 1, 2022 — during which time Smith was unlicensed.

In addition, a comparison of Compassion’s billing records with the staff work schedule allegedly showed the company had submitted payment claims for services for which there was no corresponding documentation to indicate the care was provided. There were also payment claims for services provided by a registered nurse that exceeded 24 hours in a single day, the state investigator testified.

Board cites ‘fraudulent practices,’ fabricated records

According to the board, Kebbie had no explanation for the irregularities in the nursing documentation — including instances where it appeared Compassion had billed Medicaid twice for services related to G.F.’s care.

With regard to allegations that Kebbie had improperly delegated to Smith certain tasks that were outside the scope of Smith’s license, the board concluded the documents supporting that claim were most likely fabricated by Compassion after the fact — and so, the board reasoned, there was “insufficient evidence” to support the allegation.

The board also found the evidence suggested Kebbie failed to properly delegate G.F.’s care to Smith, and alleged Kebbie admitted she had not reviewed Smith’s documentation of G.F.’s care.

As for the allegations of falsified records, the board dismissed that charge as it related to Kebbie while noting there was evidence “someone associated with Compassion” had falsified documents. Had Kebbie properly reviewed her subordinate’s records, the board said, “she would have known fraudulent practices had occurred.”

Citing what it called Kebbie’s “lack of previous disciplinary history,” the board ruled that she could retain her Iowa nursing license subject to two years of probation. However, the board’s own records indicate that in 2012, it fined Kebbie $50 for briefly working as a nurse while her license was inactive.

Nurse appeals board sanction

Last week, Kebbie’s attorney filed an appeal of that decision in Polk County District Court, arguing the sanctions are “unreasonable, arbitrary, and excessive.”

In her appeal, Kebbie alleges the matter should never have proceeded to a disciplinary hearing because the board “erred in its rejection of a settlement agreement” she and her attorney negotiated with Assistant Attorney General Samantha Wagner.

Kebbie also claims Wagner had suggested that continuing-education courses “or even a simple essay” describing the proper process for delegating duties would have been an appropriate way to address Kebbie’s conduct.

The appeal also takes issue with the fact that the state’s only witness at the hearing, aside from Kebbie, was state investigator Kathleen Beebout. In the absence of corroborating testimony to back up Beebout’s claims, Kebbie alleges, the board lacked a factual foundation to support any of the allegations against her.

Kebbie also claims the board’s allegation that she admitted failing to review a subordinate’s care for G.F. is false, and says Wagner admitted the state “has no reason to disbelieve that Ms. Kebbie is a caring nurse, that she works very hard, and that the services she provides herself are excellent.”

The state has yet to respond to the appeal.

This article first appeared in the Iowa Capital Dispatch.