Fraud and Abuse
A new HHS Office of Inspector General (OIG) analysis has identified 562 home health agencies nationwide — about 5% of all agencies — that have multiple characteristics found in OIG-investigated cases of fraud.
Steer clear of offering free administrative services that ordinarily would be the responsibility of hospital discharge planners.
Recent data reveal that a disproportionate percentage of agencies received 4.5 or 5 stars in areas including Miami, which has a reputation for being a hotbed of fraud.
Many home health industry stakeholders including the National Association for Home Care & Hospice (NAHC) are expressing displeasure about the prior authorization requirement threatening to shake the industry.
Is 100% prior authorization by a Medicare Administrative Contractor an efficient way to control home health fraud? CMS intends to find out through a demonstration that initially would affect all home health claims submitted in Florida, Texas, Illinois, Michigan and Massachusetts.
Cyberinsurance is increasingly viewed as an important tool in a health care provider’s arsenal to protect against electronic data breaches and security issues. But now that claims are beginning to be filed, some insurers are challenging their obligations to cover cyber losses.
Follow these steps to reduce the risk of your cyberinsurer not covering you should an event occur.
A recent cyberattack on a private duty agency should serve as a reminder to conduct regular system backups and take other steps to protect your agency from ransomware, a new trend in hacking.
A draft bipartisan bill to curb Medicare fraud and abuse would require agencies to have a minimum $50,000 of surety bond coverage as a condition of Medicare participation.
Griswold International, a major private duty franchisor that operates an “independent contractor system,” is the target of a fraud suit that alleges the Philadelphia company bilked 11 of its franchise holders by claiming its system wasn’t subject to the California Franchise Investment Law or to federal labor and tax regulations.


User Name: