VNAA Responds to Recent OIG Report on Home Health Fraud
Thursday, June 23, 2016
by: Visiting Nurse Associations of America

Section: Public Policy and Advocacy




VNAA appreciates the Office of Inspector General’s identification of characteristics of potentially fraudulent home health claims. 
 
The Health and Human Services’ Office of Inspector General released a report that highlights the legal settlements and prosecutions that the federal government has reached in the past year. The report references home health agencies (HHAs), individual physicians and heads of home-visiting physician companies that defrauded Medicare by, among other conduct, making (or accepting) payments for patient referrals, falsely certifying patients as homebound and billing for medically unnecessary services or for services that were not rendered.
 
According to the Office for the Inspector General, home healthcare fraud cases typically involve five characteristics, including high percentages of:
 
  1. episodes of care during which a beneficiary had no recent visits with the supervising doctors
  2. episodes of care not preceded by a hospital or nursing home stay
  3. episodes of care with a primary diagnosis of diabetes or hypertension
  4. beneficiaries with claims from multiple agencies
  5. beneficiaries with multiple home health readmission in a short time
While these five characteristics are a good first step in identifying fraud, some of the characteristics are not clear indicators of fraud. As long as there is a due process for the agencies to prove actual care, this is a very positive step.
 
Unfortunately, the Centers for Medicare and Medicaid Services (CMS) continues to move forward with their Pre-Claim Review Demonstration for Home Health Services, which will not achieve their purported claim of rooting out fraud. The five characteristics that have been proven to be effective fraud discovery devices are not a part of the Pre-Claim process. 
 
We ask that CMS uses more effective and proven methods to eliminate fraud in the home health industry and not just create administrative burden on those providing necessary care.
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