Unnecessary health care (overutilization, overuse, or overtreatment) is medical care provided at a higher volume or cost than what is appropriate or medically necessary. As of late, the home health industry has become the center of attention for medically unnecessary services and the feds aren't letting up.
Earlier this year, the Medicare Fraud Strike Force engaged in a three-day execution of one of the largest fraudulent billings takedown in history, totaling $900 million in dishonest claims. According to the Office of Inspector General, Home Health makes up a significant part of the Medicare program. There were $18.4 billion paid to more than 11,000 home health agencies in CY 2015. It's an industry vulnerable to fraud, waste and abuse with over $10 billion in improper payments received for FY 2015.
And as if these numbers aren't staggering enough, the reports keep coming in. Last week, an owner of a Houston-based home health agency was convicted for her role in a $13 million fraud and money laundering scheme. Marie Neba, co-owner of Fiango Home Healthcare Inc., received one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, one count of payment and receipt of health care kickbacks, one count of conspiracy to launder monetary instruments, and one count of making false statements. Her co-owner and husband also pleaded guilty. Both are scheduled to be sentenced on February 17, 2017.
How to Prevent Fraud and Unnecessary Medical Care
Even well intentioned providers are vulnerable to fraud. It's important for providers to be diligent in detecting billing errors to mitigate risk. Below are three steps home health agencies can take to prevent fraud and abuse:
1. Implement a culture of compliance and internal controls.
To operate effectively, it's imperative for home health agencies to implement internal controls that safeguard against government scrutiny and ensure compliance with state and federal laws. Working with an outside consultant to develop policies, audit procedures and internal review processes can make all the difference and protect your agency's integrity.
2. Conduct a staffing analysis and organizational review.
An organization is only as strong as its employees. Hiring trustworthy individuals and preforming adequate background checks is key. Preventing healthcare fraud starts with the initial background check. Home health agency owners should conduct a thorough investigation of all hires, making sure to check criminal and civil records for fraud and other crimes committed.
3. Offer employee education and training.
Home health agency owners are responsible for making sure staff members are up-to-date with new regulations impacting fraud and abuse. Staff should be trained on policies and procedures on a yearly basis—knowing what to do and how to report fraud if suspected. Garnering the expertise of a healthcare fraud expert, home health agency owners can offer "lunch and learn" opportunities for continued staff development.
Don't subject your home health agency to a fraud takedown. The ramifications can be costly and disastrous. Contact a knowledgeable healthcare fraud expert to protect your reputation and safeguard your agency from becoming the Feds next target.