Home Health & Hospice Week

Fraud & Abuse:

CMS To Take Action On More Identified Fraud Vulnerabilities, OIG Report Indicates

HHA outliers one of the few fraud risks CMS did address from 2009. The Centers for Medicare & Medicaid Services is sitting on its hands when it comes to fraud risks, according to a new HHS Office of Inspector General report. "As of January 2011, CMS had not resolved or taken significant action to resolve 77 percent of vulnerabilities reported by contractors in 2009," the OIG says in the report, "Addressing Vulnerabilities Reported by Medicare Benefit Integrity Contractors." And when it did take action, often CMS took steps not recommended by the contractors. CMS had fully resolved only two of the 62 vulnerabilities reported in the time period, the OIG adds. The benefit integrity contractors include Program Safeguard Contractors (PSCs) and Zone Program Integrity Contractors (ZPICs). One of the fully resolved vulnerabilities was in the home health industry -- unnecessary home health visits to diabetic patients. "CMS adopted a 10-percent cap [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Home Health & Hospice Week

View All