Watch Out—Rates of Fraud are Rising in the Home Healthcare System

Learning about fraud in the home healthcare industry.

In the United States, the home health industry is growing at a rapid rate.  However, this tremendous growth comes with an increased potential for abuse, and industry watchdogs have reported a steep incline in claims fraud.  To protect themselves and their patients, home health companies need to watch out for signs of fraudulent activities.  Here’s what you need to know about fraud in the home healthcare industry.

Understanding Instances of Fraud

In 2016, the U.S. Department of Health and Human Services released a report that revealed about 5% of all home healthcare agencies showed signs of fraudulent activities.  The report discussed the following five characteristics of fraud:

  1. Beneficiaries with multiple claims from multiple healthcare agencies.
  2. Care services for patients diagnosed with certain medical conditions, specifically high blood pressure and diabetes.
  3. Beneficiaries with multiple hospital readmissions within a short period of time.
  4. Care services administered to patients who had not previously been in the hospital or in a nursing home.
  5. Care services administered to patients without visits from their supervising medical providers.

While some of these characteristics may be legitimate, the report noted that many fraudulent agencies exhibited these characteristics and charged hundreds of millions of dollars in illegitimate fees.  This fraudulent billing has driven up healthcare costs significantly.

Combatting Fraud

To fight home healthcare fraud, government agencies have stepped up their regulations.  For instance, the Centers for Medicare & Medicaid Services have issued a new rule that forbids healthcare agencies in certain states from enrolling in Medicare.  This includes states like Florida, Michigan, Illinois, and Texas, where instances of fraud are prevalent.

However, it is also up to home healthcare facilities to combat fraud.  The U.S. government advises home healthcare agencies to prevent fraud by employing stricter background checks when hiring caretakers.  Agencies should also implement a zero-tolerance policy for employees who participate in theft, fraud, and other criminal behaviors.  Finally, agencies are encouraged to improve their recordkeeping and oversight by auditing claims and enrollment records more regularly.

This is what you need to know about controlling fraud in the home healthcare industry.  Want another way to protect your healthcare agency from fraudulent claims?  Then make sure you have the right business insurance in place.  For assistance with all your commercial coverage needs, contact the experts at PMC Insurance Group today.

By PMC Insurance Group

Since 1996, PMC Insurance Group has worked to help independent agents grow their client base by offering workers' compensation solutions for a wide array of businesses. As one of the most distinguished workers' compensation wholesalers in the country, we have the tools and resources to help you create coverage programs for both small businesses and large accounts.