Most issues facing today's home health and hospice agencies fall into one of three categories. Billing Compliance, Licensure Regulation and Business Operations are the three main areas that all agencies will struggle with at some point.
The entire home healthcare and hospice industry is under increasingly intense regulation and scrutiny by both federal and state oversight and investigational entities. Data driven investigations using an agency's claim payment information is widely utilized as a starting point for investigations.
The Affordable Care Act has provided new tools and resources to fight fraud in federal health care programs. The law provides an additional $350 million for health care fraud prevention and enforcement efforts, which has allowed the department to hire more prosecutors and the Strike Force to expand from two cities to nine. The act also toughens sentencing for criminal activity, enhances provider and supplier screenings and enrollment requirements and encourages increased sharing of data across government.
In addition to providing new tools and resources to fight fraud, the Affordable Care Act clarified that for sentencing purposes, the loss is determined by the amount billed to Medicare and increased the sentencing guidelines for the billed amounts, which has provided a strong deterrent effect due to increased prison time, particularly in the most egregious cases. 1 (US Justice Department Press Release June 22, 2016)
The best protection an agency can have against accusations of improper billing is an agressive and strong billing compliance program involving internal as well as external reviewers. Go to our Frequently Asked Questions or our Services page for more information on protecting your agency.
The Texas Department of Aging and Disability Services regulates home health and hospice agencies in Texas. Licensing regulations cover all aspects of agency operations from starting and agency, buying or selling an agency to the daily operations. State surveyors are responsible for onsite audits of home health and hospice agencies to ensure compliance with all state regulations and federal conditions of participation.
All agencies are confronted with operational issues involving employee performance and conduct, contract disputes with payors, solicitation of patient issues, employment contracts and an endless list of normal business related decisions. Our firm assists with not only healthcare related issues such as STARK, Anti-Kickback and licensure defense but also all aspects of assisting with human resource decisions, employment contract reviews and general litigation assistance.
Visit our Frequently Asked Questions page for common scenarios.