Home Health & Hospice Week

The Departments of Health and Human Services and Justice have a lot of reasons to ramp up their fraud-busting efforts -- 2.9 billion of them. And the feds consider home care a major risk area.

The DOJ recovered $2.9 billion in health care fraud in 2011, it reports. The dollar figure "was driven in part by unprecedented cooperation between the Department of Justice and the Department of Health and Human Services to detect and halt fraud earlier," says a release from Vice President Joe Biden. "Specifically, the Obama Administration has greatly expanded the use of Medicare Fraud Strike Forces... The teams monitor Medicare data in real time and work together to prosecute fraud much more quickly than before. It now often takes months, not years, to bring a case to resolution."

The strike force teams have seen a big jump in ROI in a short time. "In 2008, they brought cases involving $384 million in fraudulent claims," the release notes. "This year, they brought cases involving over $1 billion in fraudulent claims. For every dollar spent on this effort, the Administration has recovered seven dollars."

More to come: "The Affordable Care Act provides an additional $350 million over 10 years to ramp up anti-fraud efforts, including increasing scrutiny of claims before they have been paid, investments in sophisticated data analytics, and more 'feet on the street' law enforcement agents and others to fight fraud in the health care system," CMS says in a fact sheet.

CMS touts new abilities that haven't been used much yet, but that make providers nervous.

"One of the most powerful new tools is the new authority to suspend Medicare payments to providers or suppliers while investigating a credible allegation of fraud," CMS points out in the fact sheet. "The new rules also give [HHS] new authority to impose a temporary moratorium on newly enrolling providers or suppliers in certain geographic areas to prevent or combat waste, fraud and abuse."

CMS points out its efforts in "high risk areas" including home health and hospice. The face-to-face requirement figures prominently, as well as PECOS enrollment for ordering and referring physicians.