In an article for Bloomberg BNA addressing the rise of fraud claims against home health agencies, Bass, Berry & Sims attorney Anna Grizzle stressed the need for agencies to establish robust compliance programs to address any potential issues. In light of a recent report from the federal government detailing how home health agencies hid patients from inspectors and with several large fraud settlements against home health agencies already in the first quarter of 2018, “home health agencies should expect to be the frequent targets of audits and other enforcement activities,” said Anna.
“An effective compliance program doesn’t mean no enforcement activity will occur, but it will help the home health agencies to be prepared when responding to a government inquiry. An effective home health compliance program should include frequent claims auditing by both internal and external sources to make sure the claims are appropriately documented and supported by medical records. These audits should consider not only technical Medicare and Medicaid billing requirements but also assess the medical necessity of the claims,” Anna recommended.
The full article, “Big Ticket Settlements Show Home Care Fraud Growing,” was published by the Bloomberg BNA Health Law Resource Center on March 23, 2018, and is available online.
Additional details about fraud within the healthcare industry, including the home health sector, can be found in the Healthcare Fraud and Abuse Review 2017. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an in-depth and comprehensive review of enforcement settlements, court decisions and developments affecting the healthcare industry. Download a copy of The Review here.