Home Health & Hospice Week

Fraud & Abuse:

Avoid These 6 Red Flags

Warning: A well-known name doesn't ensure your safety.

If you want to stay out of the doghouse with the authorities when accepting advice, be on the lookout for these signs that a consultant might do you more harm than good:

 1. Stay away from consultants who lack experience or who won't provide references, says Tessa Chenaille with Chenaille Compliance Consulting in Medford, MA.

 2. Beware consultants who've developed their own reimbursement strategy and haven't had that strategy "blessed by anyone," warns attorney Rob Wanerman with Epstein Becker & Green in Washington.

 3. Avoid consultants who aren't familiar with your specialty and don't know much about the regulatory environment in which you work, Wanerman cautions.

 4. Steer clear of consultants who blindly follow the crowd. "We're way past the scenario where we can be comfortable saying we can do something because everyone else is doing it," Wanerman stresses.

 5. Absolutely avoid any consultant who promises specific results, such as a certain percentage increase in reimbursement, law firm Foley & Lardner advises.

 6. Don't agree to pay a consultant a percentage-based fee, Foley & Lardner counsels.

Don't be fooled: Many providers will go with a consultant based on the company's good reputation - but trouble last year at the well-respected consulting firm Ernst & Young proves that this isn't always a safe route, points out Wanerman.
 
Ernst & Young in 2004 lost a round in the ring with the Securities & Exchange Commission, and was barred from accepting new corporate clients for a time. An SEC administrative law judge handed down this ruling as part of Ernst & Young's punishment for inappropriately auditing a client's books while at the same time helping the company market and develop a new software product. The accounting firm also had to pay $1.7 million in restitution.
 
This punishment came on the heels of Ernst & Young being under fire for its role as HealthSouth Corp.'s auditor. The firm was sued by shareholders seeking billions of dollars in damages in connection with its audits of HealthSouth and other big companies with accounting troubles.