Home Health & Hospice Week

Dust off your compliance programs, experts say.

Home health agencies that fail to step up attention to Medicaid billing and compliance could be inviting trouble.

The Centers for Medicare & Medicaid Services announced last month the launch of an "unprecedented" crackdown on Medicaid fraud, waste and abuse.

The effort, the Medicaid Integrity Program (MIP), was created by the Deficit Reduction Act of 2005. Funding for the program starts at $5 million next year and spikes to $75 million by 2009. Contractors will monitor the actions of those seeking payment from Medicaid, will conduct audits, identify overpayments and educate providers and others on program integrity and quality of care, reports CMS.

The announcement came just before the Department of Health and Human Services announced that CMS will give states $1.75 billion over five years to allow elderly and disabled Medicaid recipients to live in the community rather than in institutions.
In 2004, Medicaid payments for home health care and personal services totaled $37.7 billion, according to the Kaiser Commission on Medicaid and the Uninsured.

Target: So far, CMS has little to say on what health care sectors the program will target. "We have just started building an organization and don't have that many specifics to offer," CMS' Barbara Cebuhar tells Eli. "We are looking at areas where historically there has been some problems with fraud and abuse."

In addition, HHAs and other health care providers are now subject to a DRA provision that mandates employee education about False Claims Act protections for so-called "whistleblowers."

Starting Jan. 1, 2007, entities that receive $5 million or more in Medicaid payments must include in their employee handbooks education about the role of the False Claims Act and similar state statutes in detecting and preventing fraud, waste and abuse in federal health care programs.

Though many HHAs will be exempt from the employee education provision, the new spotlight on routing out fraud and abuse is likely to increase False Claims cases in the Medicaid arena for all health care players, notes Connie Raffa, an attorney with Arent Fox in New York, NY.

In addition, "a federally mandated increase in state audits and scrutiny of Medicaid billings, cost reports and quality of care issues will result in more activity by state authorities, such as Medicaid Fraud Control Units," cautions Raffa, adding that an active compliance program will be increasingly essential for HHAs.