Artificial Intelligence Holds Promise in Detecting Home Health Medicare Fraud

A study on artificial intelligence (AI) suggests the technology holds promise for detecting Medicare fraud within home health and hospice. However, leaders within the industry say a measured approach should be taken, given potential shortcomings and pitfalls related to AI. The research team at Florida Atlantic University programmed computers to predict, classify and flag potentially […]

OIG Special Agents Sound Off on Hospice Fraud, CMS Rules

In one example of hospice fraud, a provider was caught billing for 17 days of general inpatient care for a 70-year-old Medicare beneficiary, though a caregiver had never even visited him. In another case, an owner a hospice was found to be using recruiters to solicit and enroll beneficiaries for hospice care when they were […]

OIG Issues Sweeping Report on Hospice Fraud and Care Quality Concerns

To counter claims of fraud and abuse in the hospice industry, federal regulators have loudly announced their plans to aggressively go after dishonest providers. Those watchdogs include the U.S. Department of Health & Human Services’ Office of Inspector General (OIG), which released a sharp new report on fraud vulnerabilities within the Medicare hospice program on […]

New York Overbilled Medicaid Home Care Program by $75 Million

New York’s Medicaid agency claimed reimbursement for some in-home care services that were not in accordance with Medicaid requirements, to the tune of $74.8 million, according to the Office of Inspector General. The state did not provide documentation of services claimed, claimed reimbursement for services that were not authorized or supported, and for claims which […]

Fraud Watch: Miami Home Health Owners Indicted in Scheme

Three Miami Home Health Agency Owners Charged in Fraud Scheme Three Miami-area home health care agency owners were charged in an indictment for their alleged participation in a health care fraud scheme involving a now-defunct business, the Department of Justice (DOJ) announced in March. Ailin Consuelo Rodriguez Sigler, 39; Ziola C. Rios, 57; and Thomas […]

Texas Home Health Care Owners Make OIG’s Most Wanted List

The Office of Inspector General (OIG) has named a former owner of a Texas-based home health care company, Ebong Aloysius Tilong, among its “most wanted fugitives.” Tilong was indicted on charges of conspiracy to commit health care fraud, health care fraud, conspiracy to pay kickbacks, payment of kickbacks and conspiracy to commit money laundering in […]

Fraud Watch: Doctor’s Conviction Overturned

New Orleans Doctor’s Fraud Conviction Overturned A New Orleans-based doctor and owner of a home health care company will likely be released from federal prison after an appeals court overturned the original conviction. Dr. Pamela Ganji and Elaine Davis were convicted of health care fraud and conspiracy to commit health care fraud in 2017. Ganji […]

OIG Notes Uptick in Home Care Medicaid Fraud Enforcement

The federal government is ramping up its efforts to nab perpetrators of Medicaid personal care services (PCS) fraud. A similar trend has been noted in Medicare home health care. Fraud indictments of PCS providers or attendants rose 56% between 2012 and 2015, while convictions increased 33% during that time, according to a new Office of Inspector General (OIG) report. […]

Hospice Honeymoon with Regulations is Over

While the home health care industry has seen more and more regulations come through that pike, hospice may appear to be a bit more of a safe haven in post-acute care. However, increasing regulation pressures are likely to advance, according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), and […]

Must-Read News: Fraud Prevention

Happy Monday, Home Health Care News readers, and welcome to October. Catch up on all things home health and home care with our weekly roundup of must-read news. Keep reading to see our most-read posts from last week—and why home health fraud is once again coming into the spotlight. Around the Web Atop the list is a […]