Home healthcare providers draw increasing scrutiny from anti-fraud enforcers

**NRSKarenRN, BSN, RN** · Jul 22, 2013

Modern Healthcare

By Joe Carlson

Posted: July 20, 2013

...Different types of groups and individuals provide a wide array of services that fall under the general description of home healthcare. For Medicare patients with acute-care needs, it often consists of skilled nursing and therapies to improve speech and movement, along with medical supplies and durable equipment. Many Medicaid home healthcare patients have chronic conditions that require treatments at home, such as diabetes. Medicare and other payers also pay for nonmedical "personal services" care, including help bathing and eating.
While nurses deliver the higher-end medical care, less-trained--and sometimes untrained--personnel can be paid to provide services as well.
In Medicaid programs, sometimes family members and friends are chosen by the beneficiary and can be paid to provide the care. That has frustrated efforts for universal background checks of lesser-skilled workers in some states because the people selected by beneficiaries might have criminal convictions.
Watchdog agencies and payers have long considered home healthcare inherently susceptible to fraud and abuse. HHS' inspector general's office recently found that as many as a quarter of all Medicare home health agencies had submitted "questionable" bills, and extraordinarily high use has been logged in places such as Miami-Dade County, Fla., and the Rio Grande Valley in South Texas.
In 2011, the CMS announced it would begin subjecting new home health providers to enhanced scrutiny allowed for "high-risk" providers under the Patient Protection and Affordable Care Act. The agency has also started using its new powers under the reform law to immediately cut off payments to home-health providers suspected of fraud, but only in coordination with other law-enforcement actions, according to a CMS e-mailed statement.
Separately, federal officials say they are using computer analytics for industries including home healthcare that will generate alerts in almost real-time about suspicious billing....

Read more: Home healthcare providers draw increasing scrutiny | Modern Healthcare http://www.modernhealthcare.com/article/20130720/MAGAZINE/307209952#ixzz2ZklKPuUI

?trk=tynt