Home Health & Hospice Week

Rest assured: The spotlight will only get brighter.

Stay current on news regarding the Medicaid fraud crackdown--or you could find yourself on the wrong side of an investigation.

The Centers for Medicare & Medicaid Services last fall announced the launch of an "unprecedented" crackdown on Medicaid fraud, waste and abuse.

Specifically, the Deficit Reduction Act of 2005 creates what's known as the Medicaid Integrity Program. Funding for the program starts at $5 million this year and spikes to $75 million by 2009. Federal and state contractors will monitor the actions of those seeking payment from Medicaid, will conduct audits, identify overpayments and educate providers and others on program integrity and quality of care.

The rule that calls for whistleblower education is in the spotlight lately. But home health agencies and durable medical equipment suppliers alike may find that it's most helpful to focus on the bigger picture, suggests attorney Kathleen Drummy, partner in the Los Angeles office of Davis Wright Tremaine.

The pressure's on: Historically, state agencies have investigated and prosecuted Medicaid false claims violations. With the enactment of the DRA, Congress has increased the level of federal participation in combating fraud, waste and abuse in the Medicaid program, explains Connie Raffa, an attorney in the New York office of Arent Fox.

Essential step: Think less about simply complying with the whistleblower education rule and more about strengthening your compliance program overall. (Look for specific how-to's in an upcoming issue of Eli's Home Care Week.)