Feds Ratchet Up Medicare Fraud Detection Efforts

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By Terry Miller, RN, C-COS 
Regulatory Advisor, McKesson
Feds Ratchet Up Medicare Fraud Detection Efforts

If you think that the federal government isn’t serious about cracking down on instances of Medicaid and Medicare fraud and abuse, think again.

During the government’s 2013 fiscal year, a record $4.3 billion was recovered, breaking the previous record of $4.2 billion. During the past five years, enforcement efforts have recovered $19.2 billion.

Although home care represents a small portion of the overall healthcare industry, we have not escaped the close scrutiny that other healthcare providers have undergone. That’s why you need to have processes in place to make sure that each care episode has been properly documented, with a signed care plan that meets current regulations.

Enforcement efforts ramped up with the creation of the Health Care Fraud Prevention Action Team (HEAT) to prevent fraud, waste and abuse of Medicare and Medicaid dollars. Although some form of fraud and abuse detection has been in place since 1997, the creation of HEAT in 2009 has accelerated these efforts. Nearly three-quarters of collections have occurred during the past five years.

These statistics should serve as a wake-up call for every home care agency in the country to closely scrutinize billing and referral practices. McKesson Homecare™ is updated regularly in response to new federal regulations.

The clinical management functionality can help your clinicians complete the OASIS assessment and other home care documentation during the initial visit without filling out individual forms. And the system reminds users when documentation hasn’t been completed or signatures are required, which can not only speed billing, it also can help your agency stay compliant.

The value of home care in the spectrum of healthcare never has been greater. So keep up the good work and make sure you have the people, the processes and the right software in place to help you stay on top of changing regulations.

To learn more about how home health software can help you stay compliant, subscribe to our blog and like us on Facebook.

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