Fraud and Abuse
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.
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.


User Name: