Several home care fraud developments in New York, Rhode Island and Louisiana have led the National Assoication for Home Care and Hospice to recommend that providers “re-double” their internal efforts against fraud.
The association points to findings from the National Council on Medicare Home Care, a NAHC affiliate, that show Medicare fraud activity in areas that have not been identified historically as high risk areas and largely falling outside of the bounds of the typical home care deception scheme.
The New York allegations are against an independent caregiver who allegedly submitted fraudulent time sheets to her employer, which was later reimbursed by Medicaid.
In Rhode Island, the state’s Executive Office of Health and Human Services has alleged St. Jude’s fraudulently billed a total of $250,000 in Medicare and Medicaid payments, removing St. Jude’s ability to bill the agencies.
And in Louisiana, seven owners and employees of a home care agency and one Medicaid beneficiary were arrested for Medicaid personal care services fraud.
The recent schemes highlight risk areas for home care agencies that have not been otherwise identified by regulatory agencies.
“As Medicaid home care spending increases, anti-fraud efforts have focused more resources in a variety of “risk areas,” NACH says in a notice to members. “Recent prosecutions have highlighted serious program integrity weaknesses in both consumer-directed and agency models of home care.… These risks may provide home care agencies with an opportunity to supply some program integrity oversight along with caregiver training and supervision.”
Further, the allegations call for more attention internally to anti-fraud measures, NAHC says.
“Home care companies doing business with Medicaid would be well served if they redouble their internal program integrity efforts,” the association writes in a member notice. “Home care companies should use service attendance and documentation systems that provide reliable ways to validate any self-submitted information. Further, agencies should engage in at least spot checks with recipients to ensure actual delivery of care and continued eligibility for services.”
Written by Elizabeth Ecker