A home health care agency that receives government reimbursement for services provided must have a compliance program in place, and the business owner or Compliance Officer should be responsible for implementing this program.
Home health care agencies must comply with many state and federal standards and regulations. To fall short of these regulations could result in serious penalties, such as heavy fines or jail time.
Checking up on non-compliance issues
Health care reform in recent years has brought about an increase in home health care agency visits from Medicaid Recovery Audit Contractors and Medicaid Integrity Contractors, groups that are now found in every state. Their job is to make sure your agency is compliant in all respects, especially in connection with coding and billing work. The Department of Health and Human Services Office of Inspector General continues to find agencies that employ workers who have committed patient abuse or neglect as well as Medicare or Medicaid fraud. When hiring any new employee, it is imperative that you perform a thorough background check, or you may find your agency accused of non-compliance in one form or another.
Developing a plan
An attorney experienced with compliance matters can help you develop a workable plan for maintaining compliance with state and federal regulations. Employee training will be very important. Here are a few items that you should include in your plan:
- Train employees on the procedures for reporting possible fraud schemes, which they should be able to do anonymously
- Ensure that employees understand there will be no backlash for reporting problems or concerns
- Document and resolve compliance issues promptly
- Review and update your compliance program on a regular basis
- Advise employees when there are updates to the program
If, as the business owner, inspectors ask you to appear for an administrative review concerning possible deficiencies or instances of non-compliance, you will want to have an experienced advocate by your side. Your attorney will put processes in place to ensure that your home health care agency is in compliance with the appropriate regulatory requirements.