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Home Health & Hospice Week

Compliance:

2 Steps Help Ward Off Payment Suspensions For 'Credible' Fraud Allegations

Published on Wed Apr 06, 2011

Home in on these 3 sources of fraud complaints. Beware a new Affordable Care Act provision that flies in the face of the "innocent until proven guilty" concept. The health care reform act signed into law last year allows the government to withhold Medicare or Medicaid payments "where there's a credible allegation of fraud," says attorney Paula Sanders with Post & Schell in Harrisburg, Pa (see Eli's HCW, Vol. XIX, No. 18, p. 138). The provision went into effect March 25. If the government decides to investigate an allegation against you, don't expect a quick resolution. The final rule implementing the provision "generally established an outside limit of 18 months for the government to conclude its investigation of the allegation," says attorney Donna Senft with Ober/Kaler in Baltimore. Definition critical: The language used related to "credible allegations" is one with "an indicia of reliability," notes Senft. And that has generated [...]
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