Fraud & Abuse:
OIG HHA Fraud Factors
Published on Fri Nov 18, 2016
Do you fall into the HHS Office of Inspector General’s high-risk profile for fraud? These five factors single you out, according to a report cited in the OIG’s new 2017 Work Plan:
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episodes for which the beneficiary had no recent visits with the supervising physician;
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episodes that were not preceded by a hospital or nursing home stay;
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episodes with a primary diagnosis of diabetes or hypertension;
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beneficiaries with claims from multiple HHAs; and
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beneficiaries with multiple home health readmissions in a short period of time.