Earlier this week, a bipartisan pair of U.S. senators released a “secret list” of nursing homes under consideration for placement on the federal government’s roster of properties with serious quality issues. Maintained by the Centers for Medicare & Medicaid Services (CMS), the list features more than 400 nursing homes that are “candidates” for the Special […]
OIG
So far, April has already seen two home health industry officials sentenced to a combined 15 years of prison time for their roles in multi-million scams, plus a conviction in the U.S. Department of Justice’s (DOJ’s) biggest health care fraud scheme ever. On April 4, DOJ announced the former director of nursing and administration of […]
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 […]
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 […]
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’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 […]
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 […]
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 […]
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 […]
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. […]
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