Posted Wednesday, August 9, 2023
McKnight’s Home Care
By: Adam Healy
In terms of False Claims Act allegations, home health has a proverbial target on its back, legal experts said at a recent webinar. And this enhanced scrutiny can be costly for providers’ balance sheets as well as their reputations, they said.
“We should definitely be making sure that we are in compliance with all of the Medicare regulations for home health agencies,” said Lourdes Martinez, a partner attorney of law firm Sheppard Mullin, which hosted a webinar earlier this month.
Litigation surrounding violations of the False Claims Act is becoming more frequent, she noted. The Centers for Medicare & Medicaid Services projected improper payment amount for home health services in 2022 to be around $1.8 billion, or an improper payment rate of 10.2%. Under the False Claims Act, the government may recoup up to three times an amount of money found to be fraudulently billed by a provider.
Common malpractices that could result in FCA allegations include kickbacks, upcoding, contracting with providers that are excluded by Medicare or Medicaid, lack of face-to-face physician visits with patients, or improper documentation of medical necessity for home health services. Providers receiving reimbursement from Medicare or Medicaid while in violation of any of these regulations are at risk of false claims action, according to the webinar.
To protect home health organizations from false claims allegations, healthcare regulatory attorney Jessica Sonpal offered providers a number of best practices. Internal audits of quality metrics can keep providers safe from FCA allegations. Medicare and Medicaid only pay for high-quality services, and data is a powerful tool to prove quality of care to the CMS. She also advised setting up a regular audit schedule, as well as monitoring claims submissions and potential overpayments received by the CMS.
In addition, Sonpal recommended organizations stay up to date on industry rules and regulations. One particular area of note: Providers should make sure they are not operating under flexibilities allowed under the COVID-19 public health emergency and should double-check their compliance with the most recent requirements, Sonpal said.
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