replace_table_token_6_th 34 recent developments home-based services when the patient protection and affordable care act ( `` ppaca `` ) was enacted in 2010 , it changed a number of medicare payment rates , including the reinstatement of the 3 % home health rural add-on , which began on april 1 , 2010 ( expired on january 1 , 2016 ) . other changes from ppaca that took effect on or after january 1 , 2011 were : reduced the market basket adjustment to be determined by cms for each of 2011 , 2012 and 2013 by 1 % ; instituted a full productivity adjustment beginning in 2015 ; and re-based the base payment rate for medicare beginning in 2014 and phasing in over a four year period . on october 30 , 2014 , cms issued a final rule ( effective january 1 , 2015 ) regarding payment rates for home health services provided during 2015. the net impact of all policies in the rule is a reduction in medicare payments of 0.3 % . cms estimated that freestanding proprietary agencies would have a 0.9 % reduction in medicare reimbursement compared with 2014 levels . the final rule included the following elements : the national , standardized 60-day episode payment rate increased from $ 2,869.27 in 2014 to $ 2,961.38 in 2015. this is a net 3.2 % increase in standardized rate , due to application of ( 1 ) a wage index budget neutrality factor ( +.24 % ) and ( 2 ) a case mix budget neutrality factor ( +3.66 % ) to the 2014 standard rate which is offset by a recalibration of the case mix , then subtracting the rebasing adjustment of - $ 80.95 ( 2.82 % of 2014 rates ) , then applying the net market basket adjustment of +2.1 % ( market basket =+2.6 % , productivity adjustment =-0.5 % ) . the 2013 office of management and budget ( `` omb `` ) core-based statistical area ( `` cbsa `` ) designations for calculating wage indexes were adopted . the proposed rule updated the hha wage index using a 50/50 blend of the existing cbsa designations and the new cbsa designations outlined in a february 28 , 2013 , office of management and budget bulletin , respectively . nationally , 37 counties shifted from urban to rural and 105 counties shifted from rural to urban . the face-to-face narrative requirement was eliminated . cms will only consider medical records from the patient 's certifying physician or discharging facility in determining initial eligibility for medicare 's home health benefit . physician claims for certification/re-certification of eligibility ( not the face-to-face encounter visit ) will be considered a non-covered service if the hha claim was non-covered because the patient was ineligible for the home health benefit . the scheduling and administration of therapy reassessments were modified to every 30 calendar days as opposed to tracking and counting therapy visits , especially for multiple-discipline therapy episodes . the 3 % rural add-on will only apply to counties that are classified as rural under the 2013 cbsa designations . nationally , 37 counties will shift from urban to rural and pick up the rural add-on , and 105 counties will shift from rural to urban and will lose the rural add-on , but may offset some of that loss by a positive increase in wage index . cms also made several minor policy changes , which will not affect reimbursement . on april 14 , 2015 , legislation was passed which limits any increase in home health payments to 1 % for fiscal year 2018 , and extends the 3 % rural home health safeguard for two years through december 31 , 2017. on october 30 , 2015 , cms released a final rule ( effective january 1 , 2016 ) regarding payment rates for home health services provided during calendar year 2016. the national , standardized 60-day episode payment rate will increase to $ 2,965.12 in 2016. the rural rate will be $ 3,054.07. this is a net 0.01 % increase in the national , standardized 60-day episode payment rate , due to application of ( 1 ) rebasing decrease of $ 80.95 , ( 2 ) case-mix adjustment decrease of 0.97 % , ( 3 ) net market basket increase of 1.9 % , ( 4 ) case-mix recalibration budget neutrality adjustment increase of 1.87 % , and ( 5 ) wage index budget neutrality adjustment increase of 0.11 % . the home health market basket percentage increase for 2016 is 2.3 % and the multifactor productivity adjustment is 0.4 % for a net home health market basket of 1.9 % . cms reduced its estimate of nominal case-mix growth between 2012 and 2014 from 3.41 % to 2.88 % ( 0.53 % ) and spread the adjustment over three years at 0.97 % each year to account for nominal case-mix growth . the finalized payment policies results in a 1.4 % reduction in medicare payments for all home health agencies . in addition , cms finalized its proposal to implement a home health value-based purchasing ( `` hhvbp `` ) program that is intended to incentivize the delivery of high-quality patient care . the hhvbp program would withhold 3 % to 8 % of medicare payments , which would be redistributed to participating home health agencies depending on their performance relative to specified measures . the hhvbp would apply to all home health agencies in arizona , florida , iowa , massachusetts , maryland , nebraska , north carolina , tennessee , and washington . story_separator_special_tag the following table summarizes general and administrative expenses ( amounts in thousands , except percentages , which are percentages of the segment 's respective net service revenue ) : replace_table_token_23_th the increase in general and administrative expenses were related to the acquisitions of deaconess and elk valley , and life care home health , inc. , which was offset by staffing efficiencies gained through our poc technology . depreciation increased due to the increase in poc devices and licenses utilized in our locations . impairment of intangibles and other consolidated impairment of intangibles and other for the year ended december 31 , 2014 was $ 3.6 million compared to $ 0.5 million for the same period in 2013. the increase relates to the consolidation of a limited number of locations in service area overlap markets and the closure of underperforming providers . goodwill and other intangible asset disposal costs for these closures were $ 1.6 million . in addition , there was $ 2.0 million related to the impairment of intangible trade name in the home health services segment . 44 interest expense consolidated interest expense for the year ended december 31 , 2014 was $ 2.5 million compared to $ 2.0 million for the same period in 2013 , an increase of approximately $ 0.5 million , or 25 % . the increase relates directly to balances outstanding on our revolving credit facility in each year , respectively . net income attributable to noncontrolling interest consolidated net income attributable to noncontrolling interest represents the minority owners ' allocable share of income in the equity joint venture partners . for the year ended december 31 , 2014 , noncontrolling interest was $ 6.9 million compared to $ 6.8 million for the same period in 2013 , an increase of approximately $ 0.1 million , or 1.5 % . liquidity and capital resources cash at december 31 , 2015 was $ 6.1 million , compared to $ 0.5 million at december 31 , 2014 . based on our current plan of operations , including acquisitions , we believe this amount , when combined with expected cash flows from operations and amounts available under our revolving credit facility will be sufficient to fund our growth strategy and to meet our anticipated operating expenses , capital expenditures and debt service obligations for at least the next 12 months . liquidity our principal source of liquidity needed to fund our operating activities is the collection of patient accounts receivable , most of which are collected from governmental and third-party commercial payors . we also have the ability to obtain additional liquidity , if necessary , through our revolving credit facility , which provides for aggregate borrowings , including outstanding letters of credit , up to $ 225 million . our reported cash flows are affected by various external and internal factors , including the following : operating results – our net income has a significant effect on our operating cash flows . any significant increase or decrease in our net income could have a material effect on our operating cash flows . timing of acquisitions – we use a portion of our operating and or financing cash flows for acquisitions . when the acquisitions occur at or near the end of a period , our cash outflows significantly increase . timing of payroll – our employees are paid bi-weekly on fridays . operating cash flows decline in reporting periods that end on a friday . self insurance plan funding – we are self-funded for health insurance and workers compensation insurance . any significant changes in the amount of insurance claims submitted could have a direct effect on our operating cash flows . cash used in investing activities primarily relates to acquisitions of home nursing and hospice agencies , while cash used by financing activities primarily relates to payments on outstanding debt agreements and payments to our noncontrolling interest partners . the following table summarizes changes in cash flows ( amounts in thousands ) : replace_table_token_24_th the acquisitions of halcyon healthcare , llc and nurses registry and home health corporation , llc affected operating cash flows for 2015. accounts receivable days sales outstanding ( “ dso ” ) for the year ended december 31 , 2015 was 46 days compared to 47 days for the same period in 2014 . 45 credit facility our revolving credit facility with capital one , national association is unsecured and provides for a maximum aggregate principal borrowing of $ 225 million ( with a letter of credit sub-limit equal to $ 15 million ) , and is scheduled to expire on june 18 , 2019. we are required to pay a commitment fee for the unused commitments at rates ranging from 0.225 % to 0.375 % per annum depending upon the company 's consolidated leverage ratio , as defined in the credit agreement . a letter of credit fee equal to the applicable eurodollar rate multiplied by the face amount of the letter of credit is charged upon issuance and on each anniversary date while the letter of credit is outstanding . the agent 's standard up-front fee and other customary administrative charges are also due upon issuance of the letter of credit , along with a renewal fee on each anniversary date while the letter of credit is outstanding . at december 31 , 2015 and 2014 , outstanding letters of credit were $ 9.8 million and $ 7.1 million , respectively , which are issued as collateral on our workers ' compensation insurance . borrowings accrue interest under the credit agreement at either the base rate or eurodollar rate are subject to the applicable margins as set forth below : replace_table_token_25_th our credit agreement contains customary affirmative , negative and financial covenants . for example , without prior approval of our bank group , we are restricted in incurring additional debt , disposing of assets , making investments , allowing fundamental changes to our business or organization

provision for bad debts consolidated provision for bad debts for the year ended december 31 , 2015 was $ 19.2 million compared to $ 15.8 million for the same period in 2014 , an increase of approximately $ 3.4 million , or 21.5 % . provision for bad debts increased in the home health services segment due to additional reserves being recorded for patient claims related to prior period patient care associated with commercial payors . accounts receivable that are aged over 365 days have increased during the period by $ 4.5 million . for home health services and facility-based services , an increase of $ 2.1 million was due to the continued backlog of medicare administrative contractor audit claims awaiting appeal hearing . appeals have historically experienced a substantial success rate in claim recovery . in addition , aged accounts receivable in our home health services and community-based services increased by $ 0.8 million due to a legacy system transition for prior year acquisitions . the remainder of the aged accounts receivable continues to be reviewed and submitted to payors for collection . all aged accounts receivable have been reserved for any estimated uncollectible accounts . general and administrative expenses consolidated general and administrative expenses for the year ended december 31 , 2015 were $ 248.6 million compared to $ 233.9 million for the same period in 2014 , an increase of approximately $ 14.7 million , or 6.3 % ; however , as a percentage of net service revenue , it is a decrease of 1.5


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```provision for bad debts consolidated provision for bad debts for the year ended december 31 , 2015 was $ 19.2 million compared to $ 15.8 million for the same period in 2014 , an increase of approximately $ 3.4 million , or 21.5 % . provision for bad debts increased in the home health services segment due to additional reserves being recorded for patient claims related to prior period patient care associated with commercial payors . accounts receivable that are aged over 365 days have increased during the period by $ 4.5 million . for home health services and facility-based services , an increase of $ 2.1 million was due to the continued backlog of medicare administrative contractor audit claims awaiting appeal hearing . appeals have historically experienced a substantial success rate in claim recovery . in addition , aged accounts receivable in our home health services and community-based services increased by $ 0.8 million due to a legacy system transition for prior year acquisitions . the remainder of the aged accounts receivable continues to be reviewed and submitted to payors for collection . all aged accounts receivable have been reserved for any estimated uncollectible accounts . general and administrative expenses consolidated general and administrative expenses for the year ended december 31 , 2015 were $ 248.6 million compared to $ 233.9 million for the same period in 2014 , an increase of approximately $ 14.7 million , or 6.3 % ; however , as a percentage of net service revenue , it is a decrease of 1.5
```    
 Suspicious Activity Report : replace_table_token_6_th 34 recent developments home-based services when the patient protection and affordable care act ( `` ppaca `` ) was enacted in 2010 , it changed a number of medicare payment rates , including the reinstatement of the 3 % home health rural add-on , which began on april 1 , 2010 ( expired on january 1 , 2016 ) . other changes from ppaca that took effect on or after january 1 , 2011 were : reduced the market basket adjustment to be determined by cms for each of 2011 , 2012 and 2013 by 1 % ; instituted a full productivity adjustment beginning in 2015 ; and re-based the base payment rate for medicare beginning in 2014 and phasing in over a four year period . on october 30 , 2014 , cms issued a final rule ( effective january 1 , 2015 ) regarding payment rates for home health services provided during 2015. the net impact of all policies in the rule is a reduction in medicare payments of 0.3 % . cms estimated that freestanding proprietary agencies would have a 0.9 % reduction in medicare reimbursement compared with 2014 levels . the final rule included the following elements : the national , standardized 60-day episode payment rate increased from $ 2,869.27 in 2014 to $ 2,961.38 in 2015. this is a net 3.2 % increase in standardized rate , due to application of ( 1 ) a wage index budget neutrality factor ( +.24 % ) and ( 2 ) a case mix budget neutrality factor ( +3.66 % ) to the 2014 standard rate which is offset by a recalibration of the case mix , then subtracting the rebasing adjustment of - $ 80.95 ( 2.82 % of 2014 rates ) , then applying the net market basket adjustment of +2.1 % ( market basket =+2.6 % , productivity adjustment =-0.5 % ) . the 2013 office of management and budget ( `` omb `` ) core-based statistical area ( `` cbsa `` ) designations for calculating wage indexes were adopted . the proposed rule updated the hha wage index using a 50/50 blend of the existing cbsa designations and the new cbsa designations outlined in a february 28 , 2013 , office of management and budget bulletin , respectively . nationally , 37 counties shifted from urban to rural and 105 counties shifted from rural to urban . the face-to-face narrative requirement was eliminated . cms will only consider medical records from the patient 's certifying physician or discharging facility in determining initial eligibility for medicare 's home health benefit . physician claims for certification/re-certification of eligibility ( not the face-to-face encounter visit ) will be considered a non-covered service if the hha claim was non-covered because the patient was ineligible for the home health benefit . the scheduling and administration of therapy reassessments were modified to every 30 calendar days as opposed to tracking and counting therapy visits , especially for multiple-discipline therapy episodes . the 3 % rural add-on will only apply to counties that are classified as rural under the 2013 cbsa designations . nationally , 37 counties will shift from urban to rural and pick up the rural add-on , and 105 counties will shift from rural to urban and will lose the rural add-on , but may offset some of that loss by a positive increase in wage index . cms also made several minor policy changes , which will not affect reimbursement . on april 14 , 2015 , legislation was passed which limits any increase in home health payments to 1 % for fiscal year 2018 , and extends the 3 % rural home health safeguard for two years through december 31 , 2017. on october 30 , 2015 , cms released a final rule ( effective january 1 , 2016 ) regarding payment rates for home health services provided during calendar year 2016. the national , standardized 60-day episode payment rate will increase to $ 2,965.12 in 2016. the rural rate will be $ 3,054.07. this is a net 0.01 % increase in the national , standardized 60-day episode payment rate , due to application of ( 1 ) rebasing decrease of $ 80.95 , ( 2 ) case-mix adjustment decrease of 0.97 % , ( 3 ) net market basket increase of 1.9 % , ( 4 ) case-mix recalibration budget neutrality adjustment increase of 1.87 % , and ( 5 ) wage index budget neutrality adjustment increase of 0.11 % . the home health market basket percentage increase for 2016 is 2.3 % and the multifactor productivity adjustment is 0.4 % for a net home health market basket of 1.9 % . cms reduced its estimate of nominal case-mix growth between 2012 and 2014 from 3.41 % to 2.88 % ( 0.53 % ) and spread the adjustment over three years at 0.97 % each year to account for nominal case-mix growth . the finalized payment policies results in a 1.4 % reduction in medicare payments for all home health agencies . in addition , cms finalized its proposal to implement a home health value-based purchasing ( `` hhvbp `` ) program that is intended to incentivize the delivery of high-quality patient care . the hhvbp program would withhold 3 % to 8 % of medicare payments , which would be redistributed to participating home health agencies depending on their performance relative to specified measures . the hhvbp would apply to all home health agencies in arizona , florida , iowa , massachusetts , maryland , nebraska , north carolina , tennessee , and washington . story_separator_special_tag the following table summarizes general and administrative expenses ( amounts in thousands , except percentages , which are percentages of the segment 's respective net service revenue ) : replace_table_token_23_th the increase in general and administrative expenses were related to the acquisitions of deaconess and elk valley , and life care home health , inc. , which was offset by staffing efficiencies gained through our poc technology . depreciation increased due to the increase in poc devices and licenses utilized in our locations . impairment of intangibles and other consolidated impairment of intangibles and other for the year ended december 31 , 2014 was $ 3.6 million compared to $ 0.5 million for the same period in 2013. the increase relates to the consolidation of a limited number of locations in service area overlap markets and the closure of underperforming providers . goodwill and other intangible asset disposal costs for these closures were $ 1.6 million . in addition , there was $ 2.0 million related to the impairment of intangible trade name in the home health services segment . 44 interest expense consolidated interest expense for the year ended december 31 , 2014 was $ 2.5 million compared to $ 2.0 million for the same period in 2013 , an increase of approximately $ 0.5 million , or 25 % . the increase relates directly to balances outstanding on our revolving credit facility in each year , respectively . net income attributable to noncontrolling interest consolidated net income attributable to noncontrolling interest represents the minority owners ' allocable share of income in the equity joint venture partners . for the year ended december 31 , 2014 , noncontrolling interest was $ 6.9 million compared to $ 6.8 million for the same period in 2013 , an increase of approximately $ 0.1 million , or 1.5 % . liquidity and capital resources cash at december 31 , 2015 was $ 6.1 million , compared to $ 0.5 million at december 31 , 2014 . based on our current plan of operations , including acquisitions , we believe this amount , when combined with expected cash flows from operations and amounts available under our revolving credit facility will be sufficient to fund our growth strategy and to meet our anticipated operating expenses , capital expenditures and debt service obligations for at least the next 12 months . liquidity our principal source of liquidity needed to fund our operating activities is the collection of patient accounts receivable , most of which are collected from governmental and third-party commercial payors . we also have the ability to obtain additional liquidity , if necessary , through our revolving credit facility , which provides for aggregate borrowings , including outstanding letters of credit , up to $ 225 million . our reported cash flows are affected by various external and internal factors , including the following : operating results – our net income has a significant effect on our operating cash flows . any significant increase or decrease in our net income could have a material effect on our operating cash flows . timing of acquisitions – we use a portion of our operating and or financing cash flows for acquisitions . when the acquisitions occur at or near the end of a period , our cash outflows significantly increase . timing of payroll – our employees are paid bi-weekly on fridays . operating cash flows decline in reporting periods that end on a friday . self insurance plan funding – we are self-funded for health insurance and workers compensation insurance . any significant changes in the amount of insurance claims submitted could have a direct effect on our operating cash flows . cash used in investing activities primarily relates to acquisitions of home nursing and hospice agencies , while cash used by financing activities primarily relates to payments on outstanding debt agreements and payments to our noncontrolling interest partners . the following table summarizes changes in cash flows ( amounts in thousands ) : replace_table_token_24_th the acquisitions of halcyon healthcare , llc and nurses registry and home health corporation , llc affected operating cash flows for 2015. accounts receivable days sales outstanding ( “ dso ” ) for the year ended december 31 , 2015 was 46 days compared to 47 days for the same period in 2014 . 45 credit facility our revolving credit facility with capital one , national association is unsecured and provides for a maximum aggregate principal borrowing of $ 225 million ( with a letter of credit sub-limit equal to $ 15 million ) , and is scheduled to expire on june 18 , 2019. we are required to pay a commitment fee for the unused commitments at rates ranging from 0.225 % to 0.375 % per annum depending upon the company 's consolidated leverage ratio , as defined in the credit agreement . a letter of credit fee equal to the applicable eurodollar rate multiplied by the face amount of the letter of credit is charged upon issuance and on each anniversary date while the letter of credit is outstanding . the agent 's standard up-front fee and other customary administrative charges are also due upon issuance of the letter of credit , along with a renewal fee on each anniversary date while the letter of credit is outstanding . at december 31 , 2015 and 2014 , outstanding letters of credit were $ 9.8 million and $ 7.1 million , respectively , which are issued as collateral on our workers ' compensation insurance . borrowings accrue interest under the credit agreement at either the base rate or eurodollar rate are subject to the applicable margins as set forth below : replace_table_token_25_th our credit agreement contains customary affirmative , negative and financial covenants . for example , without prior approval of our bank group , we are restricted in incurring additional debt , disposing of assets , making investments , allowing fundamental changes to our business or organization

