Home Health & Hospice Week

Home care providers shouldn't overlook a new law that makes identifying overpayments from the government a priority.

President Obama recently signed the Federal Enforcement and Recovery Act (FERA) of 2009 to focus on mortgage and banking fraud. But what you may not have known is that also tucked into the legislation is language that could greatly affect your home care organization.

Section 4 of the bill, titled "Clarifications to the False Claims Act (FCA) to Reflect the Original Intent of the Law," makes several changes that apply to health care providers.

First, the law defines "obligation" to include the phrase "arising from statute or regulation, or from the retention of any overpayment," regardless of whether you originally submitted a "false claim."

This suggests that you could be obligated under the False Claims Act if you have, for instance, created backdated medical records to support a claim you've already submitted, according to a release by James G. Sheehan, NewYork'sMedicaid Inspector General.

Also: "Proof of specific intent to defraud is not required under the FCA," says attorney Scot T. Hasselman with Reed Smith in Washington, D.C. Robert Markette Jr. with Milligan & Markette in Indianapolis. Home care providers "will want to mind their P's and Q's," he says.

"The bottom line is that providers should be as concerned about underpayments as they are about overpayments and have processes in place to regularly reconcile and return any overpayments to payers," Hasselman advises.