Medicare Fraud: Home Health & Hospice Agencies Beware

Over the years, our industry has seen reports of crimes related to Medicare fraud including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. Recently, the OIG released its Health Care Fraud and Abuse Control Program Report for FY2017. In its report, the OIG discusses several significant criminal and civil investigations into fraudulent practices by home health and hospice agencies.

City/State

# of Individuals Involved

Restitution

Alleged Fraudulent Services

New Orleans, LA26 & 8 years in prison; $9 million in restitutionBilling Medicare for home health services that were not medically necessary or were not provided, based upon false certifications of medical necessity.
Detroit, MI28 & 30 years in prison; $40.4 million & $38.1 million in restitutionPaying cash kickbacks to recruiters to induce patients to sign up for home health services and paying kickbacks to MDs for referrals
Northern District of OH4Participants provided forged documents and fraudulent forms to bill for services that were not provided.8 months of home confinement – 10 years in prison & more than $8 million in restitution
Chicago, IL5+Obstructing a federal audit, falsely claiming hospice patients were on general inpatient care, violating the Anti-Kickback Statute, submitting false, and inflated claims6.5 years in prison; $18 million in restitution

These cases are being prosecuted and investigated by multiple government agencies including, but not limited to, the Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the various states in which the crimes were alleged.

While these fraudulent practices were committed by individuals who were knowingly acting in a criminal manner, it is important that even honorable home health and hospice agencies ensure that their clinical documentation, coding, and billing are all clean and accurate. Obviously an error here and there doesn’t constitute fraud, but no honest agency is interested in raising any red flags that may cause CMS to take a closer look. We know that the vast majority of home health and hospice agencies are doing all the right things for all of the right people. Continue to do what you’re doing. We appreciate you!

How do you avoid making errors and mistakes that could potentially put you in the spotlight for Medicare fraud? Here are four tips that you can use!

Want to learn more about how you can adjust your operations to stand up to greater scrutiny by CMS? Read our white paper, “Home Health Regulatory Pressures Rising as Government Ramps up Fraud Protection.”

HEALTHCAREfirst, offers a number of solutions to assist home health and hospice agencies withstand higher degrees of scrutiny. Our agency management software integrates clinical decision support tools that ensure complete, compliant clinical documentation. In addition, our coding and billing experts strive to submit clean, accurate claims so you don’t have to worry about any risk of RAC audits, ZPICs, takebacks, denials, or underpayments. Lastly, our advanced analytics and Business Intelligence reporting keep you informed of what’s going on with your business so you can quickly address problems and ensure continued success.

To ensure the highest degree of regulatory compliance and agency success, our Home Health Solution Suite and Hospice Solution Suite combine the best software, services, and analytics into one integrated suite

The HEALTHCAREfirst Difference

We’re here to partner with you to make your path to compliance as simple as possible by delivering everything that you need, backed by superior support and customer service.

Contact us to learn more today!

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