To combat fraud, the hospice industry could be seen as an increasing scrutiny from the US Medicare & Medicaid Services (CMS).
Home care providers who provide hospice services, including AccentCare and Elara Caring, want Home Health Care News to CMS to act on statements about bad actors in the industry, and hope that crackdowns protect “highly integrated” providers.
Last week, CMS administrator Dr. Mehmet Oz painted a dark picture of the current state of hospice-related scams.
“Scam is a national issue, but it starts locally,” he said in an article in the Los Angeles Times. “Driving through certain areas of Los Angeles allows you to go through things that don't seem to be known to your neighbors. This can serve as a hub for criminal activity when unknown to your neighbors. There can be more than 1,000 potentially rogue hospice operations identified in Los Angeles.”
Agents will rely on the Fraud Defense Operations Centre as CMS watches in the space to deal with fraud.
“This spring we deployed the War Room (the Centre for Defence and Defence of Frauds), and our team of experts across our agency uses artificial intelligence and other cutting-edge technologies to identify fraudulent activities before paying the bill,” Oz told the Los Angeles Times.
Companies like AccentCare, which provide both home health and hospice services, welcome CMS's aggressive approach to supporting fraud.
“We hope that happens,” Dr. Balu Natarajan, Chief Medical Officer at AccentCare, told HHCN. “As an institution, we have always believed that strong program integrity measures actually increase access to high quality care. As a result, Dr. Oz and his team are strongly supporting those efforts to eliminate fraud in hospice. It's always difficult to say whether these things will happen or not.
AccentCare is a Dallas, Texas-based company that offers hospice, home health, personal care and palliative care. The company employs 30,000 team members, operates more than 250 locations in 32 states and Washington, and lives more than 200,000 people a year.
Like AccentCare, Elara Caring believes this will be a step in the right direction.
“We are fully supportive of CMS' efforts to crack down on fraud in hospice and at-home health,” an Elara compassionate spokesman told HHCN in an email. “Responsible enforcement protects patients and ensures that taxpayer dollars are used properly. It also creates an opportunity to revisit the flawed assumptions burned into recent CMS home health proposals. At home.”
Elara Caring is one of the largest home care providers in the United States. The Dallas-based company has around 200 locations in seven states and serves more than 60,000 patients. The company's service lines include home hygiene, hospice, personal care, behavioral health and palliative care.
To tackle fraud, waste and abuse, Natarajan explained that CMS should see all the signs of potential fraud.
“They need to make sure their methodology is not just about chart reviews,” he said.
Ultimately, Natarajan thinks this is net positive for all home care.
“Care for elderly patients, frail patients, elderly and severely ill patients must provide care outside the hospital,” he said. “It includes personal care services, home hygiene, palliative care, and hospice, whenever we lose faith in its acute space, patients, families, clients, the public, or non-hospital settings.
