Home Health & Hospice Week

CMS's fraud data project catches episodes ordered by ineligible physicians. If you're lax about checking the credentials of your referring physicians, you may soon pay a big price. Sixty-nine home health agencies in the Houston area are already paying it, thanks to submittingclaims that listed a physician who was ineligible to enroll in Medicare, according to the Centers for Medicare & Medicaid Services. Under its new predictive modeling fraud data program, CMS identified claims with 86 such ineligible physicians, a CMS rep tells Eli. And in late August, CMS sent letters to 69 HHAs telling them claims from just one such ineligible physician would be denied starting Sept. 2. After starting with this one case, there are "about 85 similar circumstances that we will also be addressing," the CMS source pledges. More to come: Since its initial run, CMS's Center for Program Integrity has also found more ineligible physicians, the [...]