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Home Health & Hospice Week

Fraud & Abuse:

Feds Take Aim At HHA Fraud

Published on Fri Jan 28, 2011

Predictive modeling could put your claims under intense scrutiny. The home health agency industry might explode this year, judging by all the fraud and abuse heat it's taking. A new joint report from the Department of Health and Human Services and the Department of Justice highlights the anti-fraud measures that hit HHAs in 2010, and which will continue to dog home care providers in the future. For example: "To prevent excessive payments before they are made," the Centers for Medicare & Medicaid Services' new Center for Program Integrity "began moving toward using predictive modeling techniques (similar to those currently used in the financial sector) to identify high-risk claims for further review prior to payment," HHS and DOJ explain in the annual Health Care Fraud and Abuse Control Program (HCFAC) report. CMS is conducting predictive modeling pilot projects, with home care providers as some of the first guinea pigs. "Analyses are [...]
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