Home Health & Hospice Week
Whistleblower Suits Lead To $18 Million Settlement
Plus: State cracks down on home care fraud.
Off the beaten path? Don’t assume you’re safe from the feds’ reach just because your agency isn’t in one of the HEAT task force cities.
Non-HEAT task force areas with recent fraud and abuse actions include:
Minnesota: Evercare Hospice and Palliative Care, now known as Optum Palliative and Hospice Care, will pay $18 million to settle charges that it billed for patients who weren’t terminally ill, the Department of Justice says in a release. Optum operates in 10 states, according to its website.
In the suit sparked by whistleblower filings, the DOJ said that Optum tried to maximize Medicare reimbursement without regard for patients’ prognoses. From 2007 to 2012, the company engaged in practices “allegedly included discouraging doctors from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records,” the release says.
“It is … critically important that we hold accountable those hospice providers that bill for medically unnecessary services in order to get higher reimbursements from the Medicare program,” head of the Justice Department’s Civil Division Benjamin C. Mizer says in the release.
New Jersey: Three years after his arrest on Medicaid fraud charges, People Choice Home Care Inc. owner Paul Mil has been sentenced to more than four years in prison and to repay $7 million, the DOJ says in a release. Among other misdeeds, Mil faked aides’ credentials, used proceeds of the fraud to buy real estate and personal property, and cheated on his taxes. Mil also must forfeit six homes and properties in New York and New Jersey.
Massachusetts: Nine home health agencies overbilled the state by about $22.5 million in the latest fiscal year, reports the Boston Globe. The HHAs failed to document services properly and obtain physician signatures, among other problems, according to the newspaper. The state audited claims after MassHealth’s home health spending grew more than 80 percent in one year to $755 million. The state also put a moratorium on new agencies. The nine agencies, which weren’t named, must repay the funds and implement corrective action, according to the Globe.
Home Health & Hospice Week
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Whistleblower Suits Lead To $18 Million Settlement
Plus: State cracks down on home care fraud. Off the beaten path? Don’t assume you’re [...] - HIPAA:
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Medical Necessity Drives OIG Audit Findings
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New HHA Moratoria Expands Statewide -- With Some Possible Exceptions
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Hospices Get New Billing Code For Late Certs
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