Question

An investigation by the Medicare Fraud Strike Force resulted in the discovery and ultimate sentencing of a registered nurse who defrauded her home health agency and the federal government.

a. If you were the administrator of this home health agency what could you have done to prevent this individual, or any staff member, from committing fraud of this nature?

b. What policies or procedures could you implement?

c. What actions could you enforce, within your organization that could have uncovered this illegal behavior sooner?

Answer 1

To prevent fraud activities in home health agency an administrator ahould take necesary steps as following:

1) Ensure accurate billing

2) Maintain accurate and proper documentation

3) Avoid unnecessory refferals

4) Maintain physician industry transparency

5) Disclose conflicts of interests

6) Create and follow a compliance plan

7) Seek guidance from law professionals and Government agencies.

Policies or Procedures that can be implemented against fraud activity:

1) Deploying Standardized Registration Processes

2) Verifying Provider Information with Third-Party Data

3) Tracking Business and Individual Relationships

Medical negligence liability under the consumer protection act can be applied to prevent illegal behaviour.