In an effort to curtail healthcare costs, many families prefer seeking medical care from home healthcare facilities instead of staying in hospitals for treatment.
In the United States, home care offers a wide range of medical services that can be availed by the patients in the comfort of their homes. Home care is usually less expensive and just as effective as the care that a patient gets in a hospital or skilled nursing facility.
Moving away from conventional healthcare setups doesn't ensure that you will be immune to fraudulent schemes. Several home health agencies have been sued for violating healthcare laws and industry regulations. Like any healthcare facility, a home health agency can be held liable for engaging in unlawful practices. For instance, whether or not you're a physician at a hospital or a home health agency, you can be sentenced to serve prison time for fraud.
In 2014, the Department of Justice recovered over $3.5 billion from False Claim Act cases, healthcare fraud, and abuses. As the number of cases related to medical fraud continues to soar, healthcare providers need to be more diligent when formulating their compliance programs.
Here are a few measures that home healthcare providers should follow to avoid fraud:
1. Define Your Company Policy On Fraud
When it comes to home health agencies, theft and fraud are two primary areas of concern. The risk of home health service fraud is higher, specifically for home care facilities as the employees are not supervised during work hours. Your company policy should communicate the organization's stand on the issue of theft from clients. Train your employees at regular intervals to reinstate the ethos of your company and ensure that they are well aware of the legal consequences of committing fraud.
Seek help from a healthcare attorney to draft a consolidated fraud policy for the company and make sure to put it in writing. Before you hire a new professional, have him/her sign a copy of the policy, indicating he/she understands, accepts, and agrees to abide by it.
With 86 percent of home care users being older than 63 year of age, you can include a separate section about your stance on elder financial abuse and work closely with your legal counsel to report any kind of theft to the law enforcement authority.
2. Revise Your Compliance Program
As time passes, reviewing of company policies and procedures is often forgotten. Avoid delaying this process and keep checking the latest regulations announced by the U.S Department of Health and Human Services (HHS) to avoid violation of the rules.
Remember, merely drafting a set of policies on fraud doesn't mean you are in compliance with all of them. The policies and procedures of your home health agency require a periodic review at least once a year, or as and when updates are announced by HHS.
Several law firms and insurance companies can help you stay abreast of updates on laws and rules, including the HIPAA and Privacy Compliance, HIPAA Security Rule, and Anti-Kickback Analysis. In addition, you can hire certified compliance specialists to assist your organization and address compliance concerns.
3. Establish an Efficient Reporting System
In most instances of home healthcare fraud, there is no actual home health treatment provided to the patient. Fraudsters befriend gullible patients and ask them to sign forms that verify that a nurse/physician has provided the medical services.
Patients are often unaware of the procedure to file a report against a scammer. Establishing easy and efficient reporting systems for patients to inform company officials about any dubious activities can help nip the issues in the bud.
You can also plan the medical and financial procedures of your company in a way that minimizes the role of care providers in making cash transactions. If the care provider must collect cash from the patient, then ensure that a family member monitors the accounts regularly.
4. Regularly Review Billing Documents
Fraud in home healthcare agencies occur when an attendant bills for the time that he/she wasn't actually present at the patient's house or when he/ she was providing services that are not covered under the contract. Such favors aid the fraudster to ask the patient to make a Medicaid payment for a non-qualifying service.
Review the billing or timekeeping document that your caregiver/attendant asks you to sign. Make sure the information on those documents accurately reflects both the hours that the caregiver has spent assisting you and the activities he or she has performed for you.
5. Install Proper Safeguards for Electronic Communication
Remember, it is the responsibility of every employee in your organization to ensure that all patient health information is protected. Further, they need to be extremely cautious while sharing medical records or Medicaid details with the intended recipient.
Install security software, encryption tools, and password-protected services on all electronic communication devices. You can also include a disclaimer on emails and faxes to notify the recipient after sending the email or fax.
Always emphasize that any review, dissemination, distribution, or duplication of confidential information is strictly prohibited and punishable by law. Doing so can protect you if you face any legal accusations.
It takes just one lawsuit against an organization to ruin its reputation, with no guarantee of it being restored in future. Home care agencies need to follow industry regulations strictly and ensure that their compliance processes are followed by all staff members. They should pay close attention to the compliance duties and adhere to them during ongoing shifts. They will comply with the regulations only when they see that the institution's leadership team is following the norms.
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