Part B Insider (Multispecialty) Coding Alert

Physician Notes:

OIG Escalates The Attack Against Fraudulent and Abusive HHAs

Published on Mon Jun 27, 2016

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Plus: Is telemedicine the future of healthcare?

The rise of Home Health Agencies (HHA) and the care they offer have greatly benefited patients nationwide. Sadly, these crucial services – skilled nursing care, home-based assistance, and therapeutic services for qualifying homebound individuals – have been plagued with fraudulent activity and patient abuse.

“Home health has long been recognized as a program area vulnerable to fraud, waste, and abuse,” says the OIG in a report published June 21. “Home health investigations have resulted in more than 350 criminal and civil actions and over $975 million in receivables for fiscal years 2011-2015 covered by Medicare.”

The data highlights the measures of the activity while identifying that the majority of the offenders seem to be concentrated in what OIG calls “geographic hotspots.” These particular areas of the country have a larger than average number of HHAs committing Medicare fraud.

Resource: For more information about the OIG’s efforts to stop HHA fraud, visit http://oig.hhs.gov/oei/reports/oei-05-16-00031.asp.

In other news…

As telemedicine use has increased to remotely diagnose and treat patients via various telecommunication platforms, the need for stricter guidelines has presented itself.

The American Medical Association (AMA) discussed the emergence of this technology and the new and innovative healthcare challenges that come from utilizing it, at its annual meeting in Chicago on June 13. The discourse centered on telemedicine and ethics with the proposition of guidelines to address this critical issue.

“Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions,” said AMA Board Member Jack Resneck, MD, at the annual meeting. “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”

The AMA continues to encourage the highest level of patient engagement and the administration of quality care, says the AMA in a news release from June 13. The guidelines put forth are a promise that the group will promote safety and integrity first in telemedicine, ensuring the welfare of their patients for the long term.

Resource: For the complete AMA news release about new telemedicine initiatives, visit http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-13-new-ethical-guidance-telemedicine.page.