Eli's Hospice Insider

Published on Wed Oct 19, 2011 PDF

States are looking at hospice-nursing home relationships.

• Home Health and Hospice Medicare Administrative Contractors. Whether your contractor is Palmetto GBA, CGS, or National Government Services/ NHIC, reviewers can ADR your claims.
• Recovery Audit Contractors. RACs may not have hit hospice directly yet, noted Debra Sellers, director of home care services for St. John's Health System in Springfield, Mo, at the National Association for Home Care & Hospice annual meeting in Las Vegas. But they are making recoupments from durable medical equipment suppliers who furnished equipment in hospice benefit periods. Don't be surprised to see hospices hit soon, Sellers told attendees at her Oct. 4 education session. Find out which of the four RACs is yours at www.cms.gov/recovery-audit-program.
• Medicaid Integrity Contractors. MICs have been looking at hospice-nursing home relationships in some states, Sellers related. Beware of kickbacks disguised through inflated room and board payments.
• Zone Program Integrity Contractors. ZPICs took over fraud-fighting functions from then-intermediaries.
• The Health Care Fraud Prevention and Enforcement Action Team (HEAT). The HEAT strike forces currently operate in seven cities (Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Miami-Dade and Tampa Bay) and are likely to expand further.
• Medicaid Fraud Control Units. MCFUs have been working hand-in-hand with HEAT teams to bust fraudsters.
• State Survey Agencies.
• Comprehensive Error Rate Testing (CERT) contractor.
• Payment Safeguard Contractors (PSCs).
• HHS Office of Inspector General.