Home Health & Hospice Week

Real-time data mining may nab more subtle errors.

The spectacular scope of two fraud cases that led to record-breaking prison terms may pose a danger to home health agencies.

The cases for Dr. Jacques Roy and Marie Neba (see story, p. 232) “are very blatant examples of fraud and it may lead to a false sense of safety for many providers,” warns Washington, D.C.-based healthcare attorney Elizabeth Hogue. “Providers may say to themselves, ‘Well, we aren’t doing anything as blatant as they were, so we probably don’t have to worry.’”

It may be true that “enforcers are still ‘harvesting’ low-hanging fruit, but with the availability of claims data in almost real time now and data mining, enforcers are moving on to less blatant activity,” Hogue cautions.

Bottom line: “These examples should cause providers to redouble their efforts to develop a culture of compliance within their organizations and to keep their Fraud and Abuse Compliance Plans up-to-date and fully implemented,” Hogue urges.

Tip: Try integrating your compliance efforts into your quality improvement plan. (See more compliance pointers in Eli’s HCW, Vol. XXII, No. 22.)