Fraud and Abuse
The case of the registered nurse who wasn’t serves as a reminder to keep your licensure checks tight.
The HHS Office of Inspector General (OIG) will turn its attention next year to the frequency with which hospice RNs conduct supervisory visits of aides, according to its new work plan published Nov. 10.
Perform surprise visits during personal care aide shifts to determine if your employees are at clients’ homes when they’re scheduled to be, thus avoiding the possibility of Medicaid paying out for services not performed.
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.


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