On December 19, 2012 the Department of Justice announced the owners and operators of two Miami health care agencies pleaded guilty for their participation in a $48 million home health Medicare fraud scheme. According to plea documents, the owners conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. The owners and their alleged co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Caring Nurse Home Health Corp. (“Caring Nurse”) and Good Quality Home Health, Inc. (“Good Quality”), as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. The owners used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which the owners knew was in violation of federal criminal laws. (more…)
Posts Tagged ‘fraud’
Two Florida Home Health Agency Owners Plead Guilty to Fraud
Inappropriate and Questionable Billing by Medicare Home Health Agencies
Data collected and analyzed by the Office of Inspector General (OIG) since 2010, indicate that home health agencies (HHAs) are predisposed to commit Medicare fraud, waste and abuse. In 2010, Medicare inappropriately paid $5 million for erroneous claims submitted by HHAs. With one in four claims being suspect, the OIG established six (6) criteria that identify HHAs submitting potentially fraudulent claims and/or employing questionable billing practices. Primarily, these criteria are based on higher than average payments, visits, late episodes, therapy visits and Medicare payment amounts per beneficiary, as well as a higher than average number of beneficiaries. (more…)
CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings
The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. The final rule will be published in the April 27th Federal Register, and the rule will become effective 60 days after publication, June 26.
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