Fraud and Abuse
Employee embezzlement is rampant in health care. It can also be very difficult to prevent.
A huge embezzlement case in New York’s Nassau County is a stark reminder that health care providers are potential targets for embezzlers, and many providers don’t make the simple adjustments that can prevent it from happening to them.
The government’s approach to compliance keeps evolving, with new trends emerging every year.
Ensure sound protocols are in place for how to respond when an employee alerts you that your agency may have admitted ineligible patients. And make sure to follow through with those protocols.
Many of the most recent civil monetary penalties and affirmative exclusions imposed by the HHS Office of Inspector General (OIG) involved settlements by providers for employing an excluded individual.
Educate your patients about their new Medicare cards and the ways people can protect themselves from fraud associated with the cards.
Experts say there has been an increasing focus on fraud enforcement when it comes home health care involving Medicaid. This makes it even more important to be sure you’re hiring the right staff and double checking that the services you bill for were in fact provided.
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.


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