Home Health & Hospice Week
HHAs Serve As Test Subjects For Fraud Baseline
Home health is serving as a guinea pig in one Medicare fraud initiative, reveals a new Gov-ernment Accountability Office report.
The Department of Health and Human Services is trying to establish a "health care fraud baseline." The baseline will facilitate evaluation of fraud prevention activities’ success, the GAO says in the report (GAO-13-746).
Under the pilot program, CMS and its contractor will collect information from home health agencies, referring physicians, and beneficiaries selected randomly. "The pilot will rely on the information collected along with a summary of the service history of the home health care agency, the referring provider, and the beneficiary to estimate the percentage of total payments that are associated with probable fraud, and the percentage of all claims that are associated with probable fraud for Medicare fee-for-service home health care," the GAO explains.
The program began data collection in May 2013, which will take two years, the GAO says. CMS will decide whether to expand the baseline project to other provider types after analysis of the home health project.
The baseline project "could provide policymakers with information on how much fraud exists and in coming years, how potentially fraudulent activity has increased or decreased over time," the GAO praises in the report at www.gao.gov/assets/660/658344.pdf.
Home Health & Hospice Week
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