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 […]
The Medicare Fraud Strike Force has 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 […]
Days after unveiling a preauthorization requirement for home health agencies, providers expressed confusion and concern as the Centers for Medicare & Medicaid Services (CMS) attempted to clarify what the plan entails. The new preauthorization measure, dubbed the Pre-Claim Review Demonstration for Home Health Services, aims to crack down on Medicare fraud, waste and abuse in […]
There’s been an increasing focus on remote monitoring in the home health sector as of late, with multinational tech giant Philips (NYSE: PHG) among those betting on these types of devices. However, there’s little evidence, if any, showing they improve health outcomes, according to recent research published in the International Journal of Medical Informatics. Internet-linked products and home […]
Cigna Corp. has urged an Illinois federal court to drop a ‘flawed’ home care false claims suit, which accuses Addus HomeCare Corp. (NASDAQ: ADUS) and a Cigna subsidiary of bilking the government of millions of dollars by providing Medicare- and Medicaid-covered services to people who didn’t need them. A complaint filed by Stop Illinois Marketing […]
The former leader of a Pittsburgh-area hospice company has pleaded guilty following accusations of using patients who weren’t terminally ill to collect millions of dollars in false Medicare and Medicaid billings. Mary Ann Stewart, a 48-year-old from Carrolltown, Pennsylvania, and ex-COO of Horizons Hospice, was indicted last year on one count of health care fraud and […]
The owner of a New Jersey home health agency has been sentenced to five years in prison for her role in a $7 million scheme to defraud Medicaid. In addition to the prison term administered Tuesday, Irina Krutoyarsky, 62, of Springfield, New Jersey, was sentenced to three years of supervised release and was ordered to pay […]
American Hospice Management Holdings has filed for bankruptcy protection amid “severe financial stress,” leaving the hospice care provider six weeks to sell its business. Already, Hospice Partners of America made a “stalking horse” bid to acquire American Hospice’s operations in Virginia and Texas, leaving operations in Arizona, Florida, Georgia, New Jersey and Oklahoma up for […]
This week, our readers were keen on how home health house calls can reduce hospital admissions and care costs. They also wanted to know why one health network is looking beyond hospital readmission rates to form its home health partnerships. Here in the newsroom, we took notice of InnovAge’s decision to transition from a non-profit […]
With several CMS initiatives underway, including value-based purchasing and bundled payments, telemedicine has been on the minds of lawmakers as a way to help keep patients healthy and happy in their homes longer. Last week, Senators Cory Gardner (R-CO) and Gary Peters (D-MI) introduced the Telehealth Innovation and Improvement Act, which would expand access to telemedicine […]
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