Home Health & Hospice Week

Separate payment for nonhospice items gets more attention.

A new joint report from the Department of Justice and HHS Office of Inspector General shows home health and hospice agencies remain firmly in the feds’ crosshairs.

In the Health Care Fraud and Abuse Control Program Fiscal Year 2022 Report, the DOJ and OIG run down a laundry list of home health and hospice fraud cases.

For example: Medicare paid more than $40 million for home health services that were not provided, and the fraud proceeds were laundered by a Pakistan-based home health “consulting” company, the report notes. In the end, the defendant was sentenced to 12 years in prison.

Another example: In August 2022, 13 defendants were sentenced to a combined 84 years in federal prison for their roles in causing $27 million in fraudulent hospice services claims to be paid by Medicare and Medicaid to Novus Health Services.

The report also hits on report topics including proration for early discharge to inpatient rehab facilities, and payments for DME and other nonhospice items and services for hospice patients. And it points out added hospice survey protocols.

In 2022, the DOJ opened more than 809 new criminal health care fraud investigations and filed criminal charges in over 419 cases involving at least 680 defendants, the report says. OIG activities resulted in 661 criminal actions and 726 civil actions. The watchdog agency also excluded 2,332 individuals and entities from participation.

“HHS OIG focuses on combating Medicare and Medicaid fraud, waste, and abuse, including in priority areas such as … enhancing program integrity in noninstitutional care settings, such as home health and hospice care,” the agency says in the 139-page report at https://oig.hhs.gov/publications/docs/hcfac/FY2022-hcfac.pdf.