Home Health & Hospice Week

Poor data is keeping Medicare's fraud contractors from overseeing you like they should. So says the HHS Office of Inspector General in a new report. "The lack of uniformity in [Zone Program  Integrity Contractors'] reporting of data is  similar to issues we identified more than 10 years ago in a review of Medicare Part A fraud units," the OIG says in its new report at http://go.usa.gov/IZS.

Revamping the Medicare contractor system so that ZPICs handle fraud separately from MACs doesn't seem to be fixing the problems the OIG has been highlighting for a decade.

Among other things, the Centers for Medicare & Medicaid Services needs to "ensure that ZPICs have access to all data necessary to effectively carry out their program integrity activities," the OIG recommends in the report. In its response to the report, CMS agrees with that.

From Feb. 1 through Oct. 31, 2009, the two ZPICs studied generated only about 100 cases each of potential fraud using the limited data during a nine-month period, notes the Associated Press. That's a drop in the bucket compared to the billions of dollars of fraud occurring annually.

If anything, many home care providers are more frustrated than the OIG with the feds' fraudfighting efforts. "If the OIG wants to stop fraud they should get off the 'it has to be $3 million before we look' attitude," says Lynn Olson, owner of billing company Astrid Medical Services in Corpus Christi, Texas. "If they would hit a bunch of 'small acts of fraud' in a widespread area, people would realize it could happen to them and would respond accordingly," Olson tells Eli.