Editor’s Picks: Fraud, Fraud, Fraud

This week, Home Health Care News readers read up on three main topics: reimbursement, coding and fraud. The Medicare Fraud Strike Force charged about 300 people—including some in the home health industry—in a variety of schemes that involved more than $900 million in fraudulent health care billings, and the Office of the Inspector General identified more than 500 home health agencies and 4,500 physicians nationwide as having “suspicious” practices.

HHCN readers also learned just how much trouble home health agency staff members nationwide are having in mastering OASIS skills, and the best ways to go about preparing for CMS’ upcoming prior authorization demonstration.

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Feds Target Home Health in Historic, $900 Million Fraud Bust—The Medicare Fraud Strike Force engaged in a three-day execution of the largest fraudulent billings takedown—that includes home health agencies—in the group’s history. Approximately 300 people were charged across 36 federal districts for their alleged participation in a variety of schemes that involved more than $900 million in fraudulent health care billings, according to Attorney General Loretta Lynch.

Tips for Home Health to Prepare for Pre-Claim Submissions—With the Center for Medicare & Medicaid Services’ (CMS) prior authorization program—dubbed the Pre-Claim Review Demonstration for Home Health Services—launch date coming up quickly, there are a few things home health agencies can do to be prepare for the changes and reduce the likelihood of delayed or denied reimbursement payments. Gina Mazza, partner at Fazzi Associates, doled out advice about the program during a recent webinar.

Home Health Agencies Failing to Master OASIS Skills—Home health agency staff do not have nearly as firm a grasp on the Outcome and Assessment Information Set (OASIS) as they should—and that could spell trouble for agencies nationwide. On average, home health managers’ OASIS competencies come in at around 74%, according to data from Fazzi Associates. Auditors’ OASIS competencies come in at only 83% on average, Fazzi found. “Given the critical nature of OASIS, these scores should be higher,” Fazzi Associates founder and Managing Partner Bob Fazzi said.


OIG Flags 500 Home Health Agencies as Fraud Battle Intensifies—Federal authorities are turning up the heat even more in their battle against Medicare home health fraud. The top targets: More than 500 home health agencies and 4,500 physicians identified as having suspicious practices as compared with most providers nationally.

Weekend Read

The Apple Watch Just Made Calling for Emergency Health Much Easier—Apple announced that its Apple Watch will have a new “SOS button,” which enables users to call emergency services by pressing the sidebar and holding it down for a few seconds. The Apple Watch also has the ability to send a message with its wearer’s location to some or all of their emergency contacts, Popular Science reported.

Written by Mary Kate Nelson

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