Fraud and Abuse
A recent court case involving Encompass Senior Solutions in Omaha, Neb., serves as a reminder to reevaluate your policies to protect employees in the home.
If you have strong evidence that a hospital is failing to offer patients a reasonable choice of post-acute care providers, contact its CEO or ask your state survey agency to conduct a complaint survey.
Two recent home health fraud investigations involving tens of millions of dollars underscore the need to report fraud when your agency becomes aware of it. But in many cases, before contacting authorities, consider talking with competing agencies or referral sources about their improper conduct.
Expect stricter requirements for screening caregivers who provide home and community based care if the HHS Office of Inspector General (OIG) has its way.
Deploying yet another weapon in its battle against home health fraud, CMS has expanded the number of metropolitan areas where Medicare enrollment of new agencies is temporarily suspended to the include Fort Lauderdale, Detroit, Dallas and Houston metropolitan areas, effective Jan. 31.
The owner of an Arlington, Texas-based home health agency, who claimed more than $40 million in medically unnecessary home health services, has been sentenced to more than 10 years in prison and ordered to pay nearly $25.5 million in restitution.
A growing number of states are hiring telephony vendors to help them find out whether patients actually received the number of visits that Medicaid paid for. For affected agencies, though, such monitoring often means extra work.
A new False Claims Act suit against a South Florida home health agency indicates the Justice Department’s reliance on home health employees to uncover possible Medicare fraud continues to grow.
A new advisory bulletin from the HHS Office of Inspector General (OIG) spells out more clearly what the government expects you to do to avoid billing for services provided or ordered by excluded individuals. Billing for such services is subject to penalties of up to $10,000 per item or service furnished by the excluded individual, plus three times that amount in damages and loss of your Medicare certification.
Some home health agencies that recently had their request for anticipated payment (RAP) dollars suppressed by Medicare administrative contractor (MAC) Palmetto GBA will be immediately eligible for reinstatement.


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