Home Health & Hospice Week

Authorities aren’t giving personal care services providers a pass anymore.

If you think Medicare is the only government payer coming back to recoup overpayments, think again.

In its report The Department of Justice Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2012, the Depart-ment of Health and Human Services (HHS) notes that it recovered a record $835.7 million from those who attempted to defraud Medicaid in 2012. The unprecedented amount of Medicaid dollars recouped was included in the $4.2 billion total that the government recovered from providers that fraudulently billed federal healthcare programs.

In the report, HHS cited multiple cases in which the OIG found personal care service providers’ claims improper because of problems such as attendants lacking required qualifications or training.

HHS released the report right around the same time that the HHS Office of Inspector Gen-eral issued a separate document stating that CMS is behind on collecting $225.6 million in Medicaid overpayments that were identified prior to 2010. The OIG urged CMS to follow up on collecting those overpayments.

            Bottom line: If you’ve collected too much from Medicaid, the government may come calling for a refund soon.

            The HCFAC report also cites the laundry list of home health providers indicted for Medicare fraud last year in Miami, Texas, and Detroit.

            Resources: To read the OIG’s complete reports, visit https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2012.pdf and https://oig.hhs.gov/oas/reports/region5/51100071.pdf.