HHS Issues New Rules to Unclog Medicare Appeals Pipeline

After a damning report from the U.S. Government Accountability Office (GAO) on the rising number of Medicare claims appeals and the resulting dramatic backlog of unresolved cases, the latest proposed changes to clear out the backlog have appeared. Medicare Administrative Contractors (MACs) process an estimated 1.2 billion fee-for-service claims on behalf of the Centers for […]

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. To identify these providers, the Office of Inspector General (OIG) for the Department of Health and […]

OIG: Free Introductory Home Health Visits Are Not Patient Bribes

Free introductory visits offered by one home health care provider don’t violate the anti-kickback statute or the civil monetary penalties law, according to an advisory opinion recently issued by the Department of Health and Human Services Office of Inspector General (OIG). The opinion comes following a ruling on home health referrals earlier this year in which […]

Indiana Home Health Companies to Pay $1.5 Million in Fraud Settlement

Indianapolis-based United Home Healthcare, Inc. and B&L Personal Services, Inc. — known collectively as United, and owned and operated by Byron and Laura Harris — have settled charges that they were billing for services they didn’t provide. The civil settlement, announced by Josh J. Minkler, U.S. attorney for the Southern District of Indiana, will result in […]

New HHS Fall Prevention Program Keeps Seniors at Home Longer, for Cheaper

The Department of Health and Human Services (HHS) is banking on a new fall prevention program that aims to help seniors continue living at home longer and delay the move to costlier care settings like nursing homes and long-term care facilities. Developed by HHS, the comprehensive prevention program includes clinical in-home assessments of health, physical […]

Supreme Court Rules Against Home Health Companies Seeking Higher Payments

Home health agencies and other providers cannot sue states for setting low Medicaid reimbursement rates, the U.S. Supreme Court ruled in a 5-4 decision announced today. The case was brought by five providers of in-home care and other services in Idaho, led by Exceptional Child Center, which provides home care for people with developmental disabilities […]

Feds Track Down Accused Fraudsters in $2.4 Million Home Health Scheme

Three individuals have been arrested for more than $2.4 million in Medicare and Medicaid fraud involving home health-related kickbacks and bribes, according to the United States Attorney’s Office for the Southern District of Florida. One of the accused was detained in Colombia, the federal authorities announced. The defendants — Daniel Ronchetta, M.D., chiropractic physician assistant […]

HHS Awards States $665 Million to Design, Improve Health Care Delivery

Twenty-eight states, three territories and the District of Columbia will be the beneficiaries to over $665 million in Affordable Care Act funding to design and test health care payment and service delivery models that strive to both improve health care quality and lower costs, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced Tuesday. […]

Medicare, Medicaid Net $2.3 Billion in Health Care Fraud Recoveries in 2014

The U.S. Department of Justice (DOJ) obtained a record $5.69 billion in settlements and judgments from cases involving fraud and false claims against the government in the fiscal year ending September 30, the federal agency announced in a report Thursday. Of that total, $2.3 billion was recovered from health care-related frauds.  FY 2014 marked the fifth […]

OIG to Focus on Home Health Payments, Hospice in Senior Living in 2015

The Office of the Inspector General (OIG) has released its work plan for 2015, addressing various issues relating to home health care and hospice.  Among the topics addressed are the home health prospective payment system, fraud, health screening, hospice patients’ length of stay in assisted living facilities and the appropriateness of hospices’ general inpatient care […]